Provider Demographics
NPI:1477878460
Name:WEEMS, DANYALE (LCSW, CCTP, RPTS)
Entity type:Individual
Prefix:MRS
First Name:DANYALE
Middle Name:
Last Name:WEEMS
Suffix:
Gender:F
Credentials:LCSW, CCTP, RPTS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:856 OLD ANTIOCH RD
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:GA
Mailing Address - Zip Code:30117-7837
Mailing Address - Country:US
Mailing Address - Phone:970-682-9097
Mailing Address - Fax:
Practice Address - Street 1:2717 N HIGHWAY 27
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:GA
Practice Address - Zip Code:30117-9349
Practice Address - Country:US
Practice Address - Phone:470-244-2574
Practice Address - Fax:678-890-1518
Is Sole Proprietor?:No
Enumeration Date:2010-04-01
Last Update Date:2018-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
GACSW0055811041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA0031652888BMedicaid