Provider Demographics
NPI:1265536411
Name:ZIMMERMAN, LISA DAWN (MSW, LCSW)
Entity type:Individual
Prefix:MRS
First Name:LISA
Middle Name:DAWN
Last Name:ZIMMERMAN
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2630 STONEHILL DR
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30041-9306
Mailing Address - Country:US
Mailing Address - Phone:678-630-9036
Mailing Address - Fax:678-807-8573
Practice Address - Street 1:6645 PEACHTREE DUNWOODY RD NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30328-1606
Practice Address - Country:US
Practice Address - Phone:404-550-3077
Practice Address - Fax:770-455-7118
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-11
Last Update Date:2010-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS21428104100000X
GACSW0040281041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker