Provider Demographics
NPI:1063530947
Name:ZABEL, REGINA A (LCSW, ACSW)
Entity type:Individual
Prefix:
First Name:REGINA
Middle Name:A
Last Name:ZABEL
Suffix:
Gender:F
Credentials:LCSW, ACSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1479 BROCKETT RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:TUCKER
Mailing Address - State:GA
Mailing Address - Zip Code:30084-7326
Mailing Address - Country:US
Mailing Address - Phone:678-754-3018
Mailing Address - Fax:404-508-8944
Practice Address - Street 1:1479 BROCKETT RD
Practice Address - Street 2:SUITE 101
Practice Address - City:TUCKER
Practice Address - State:GA
Practice Address - Zip Code:30084-7326
Practice Address - Country:US
Practice Address - Phone:678-754-3018
Practice Address - Fax:404-508-8944
Is Sole Proprietor?:No
Enumeration Date:2007-03-27
Last Update Date:2012-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0036891041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA747634110BMedicaid
GA747634110AMedicaid