Provider Demographics
NPI:1669199451
Name:PANTNER, YVANNA (LMSW)
Entity type:Individual
Prefix:
First Name:YVANNA
Middle Name:
Last Name:PANTNER
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:119 E COURT SQ STE 210
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30030-2522
Mailing Address - Country:US
Mailing Address - Phone:434-382-9417
Mailing Address - Fax:
Practice Address - Street 1:119 E COURT SQ STE 210
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30030-2522
Practice Address - Country:US
Practice Address - Phone:404-492-6121
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-24
Last Update Date:2024-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMSW0115301041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical