Provider Demographics
NPI:1861675225
Name:AIRALL, ROSITA B (LCSW)
Entity Type:Individual
Prefix:MS
First Name:ROSITA
Middle Name:B
Last Name:AIRALL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4420 SIRROCCO LN SW
Mailing Address - Street 2:
Mailing Address - City:LILBURN
Mailing Address - State:GA
Mailing Address - Zip Code:30047-7434
Mailing Address - Country:US
Mailing Address - Phone:678-887-4500
Mailing Address - Fax:770-828-0693
Practice Address - Street 1:2140 MCGEE RD STE C140F
Practice Address - Street 2:
Practice Address - City:SNELLVILLE
Practice Address - State:GA
Practice Address - Zip Code:30078-2975
Practice Address - Country:US
Practice Address - Phone:678-887-4500
Practice Address - Fax:770-828-0693
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-07
Last Update Date:2009-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0017661041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000923381BMedicaid