Provider Demographics
NPI:1952001331
Name:EARLY, PATRICE (LCSW)
Entity type:Individual
Prefix:
First Name:PATRICE
Middle Name:
Last Name:EARLY
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 1:1900 TURNER RD SE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30315-6949
Mailing Address - Country:US
Mailing Address - Phone:404-207-2236
Mailing Address - Fax:
Practice Address - Street 1:495 CHARLES HARDY PKWY
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:GA
Practice Address - Zip Code:30157-5723
Practice Address - Country:US
Practice Address - Phone:855-417-2486
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-06
Last Update Date:2024-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAGACSW008424101YM0800X
MI68011179771041C0700X
TN92361041C0700X
GACSW0084241041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health