Provider Demographics
NPI:1205841780
Name:DESILVA, SUSANAH (LCSW)
Entity type:Individual
Prefix:MS
First Name:SUSANAH
Middle Name:
Last Name:DESILVA
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 1:3863 GA-138
Mailing Address - Street 2:
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-9058
Mailing Address - Country:US
Mailing Address - Phone:470-651-6704
Mailing Address - Fax:844-492-1148
Practice Address - Street 1:1311 PEBBLE RIDGE LN
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:GA
Practice Address - Zip Code:30228-6121
Practice Address - Country:US
Practice Address - Phone:470-651-6704
Practice Address - Fax:844-492-1148
Is Sole Proprietor?:No
Enumeration Date:2006-07-30
Last Update Date:2024-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0032201041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical