Provider Demographics
NPI:1265710743
Name:FORBES, KHAALIDA TAHIRA (LICSW, PHD)
Entity type:Individual
Prefix:DR
First Name:KHAALIDA
Middle Name:TAHIRA
Last Name:FORBES
Suffix:
Gender:F
Credentials:LICSW, PHD
Other - Prefix:
Other - First Name:KHAALIDA
Other - Middle Name:TAHIRA
Other - Last Name:SMALLS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4650 FLAT SHOALS PKWY
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30034-5000
Mailing Address - Country:US
Mailing Address - Phone:404-243-9336
Mailing Address - Fax:404-212-1265
Practice Address - Street 1:4650 FLAT SHOALS PKWY
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30034-5000
Practice Address - Country:US
Practice Address - Phone:404-243-9336
Practice Address - Fax:404-212-1265
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-01
Last Update Date:2014-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD168101041C0700X
GACSW0051581041C0700X
DCLC500788041041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical