Provider Demographics
NPI:1801919246
Name:EBLIN, ALTA B (LCSW)
Entity type:Individual
Prefix:DR
First Name:ALTA
Middle Name:B
Last Name:EBLIN
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 1:2257 BRIANWOOD TRL
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30033-1719
Mailing Address - Country:US
Mailing Address - Phone:404-634-1791
Mailing Address - Fax:
Practice Address - Street 1:2931 PACES FERRY RD SE
Practice Address - Street 2:SUITE 1
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30339-3732
Practice Address - Country:US
Practice Address - Phone:770-432-9750
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1381041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical