Provider Demographics
NPI:1922303833
Name:COLLIS-ABDULLA, MALISSA KATHERINE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:MALISSA
Middle Name:KATHERINE
Last Name:COLLIS-ABDULLA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:MALISSA
Other - Middle Name:KATHERINE
Other - Last Name:COLLIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:4706 CAMBRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30338-5004
Mailing Address - Country:US
Mailing Address - Phone:678-777-2317
Mailing Address - Fax:
Practice Address - Street 1:1670 CLAIRMONT RD
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30033-4004
Practice Address - Country:US
Practice Address - Phone:404-321-6111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-24
Last Update Date:2011-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA7331041C0700X
GA1041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool