Provider Demographics
NPI:1740355833
Name:DAVIDSON, BEVERLY (LCSW)
Entity type:Individual
Prefix:MS
First Name:BEVERLY
Middle Name:
Last Name:DAVIDSON
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 1:4501 CIRCLE 75 PKWY SE
Mailing Address - Street 2:SUITE E-5220
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30339-3025
Mailing Address - Country:US
Mailing Address - Phone:770-955-9411
Mailing Address - Fax:770-690-8953
Practice Address - Street 1:4501 CIRCLE 75 PKWY SE
Practice Address - Street 2:SUITE E-5220
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30339-3025
Practice Address - Country:US
Practice Address - Phone:770-955-9411
Practice Address - Fax:770-690-8953
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0017211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical