Provider Demographics
NPI:1063913283
Name:LEVY, SUSAN JOY (LMFT, LPC)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:JOY
Last Name:LEVY
Suffix:
Gender:F
Credentials:LMFT, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:455 E PACES FERRY RD NE STE 201
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30305-3319
Mailing Address - Country:US
Mailing Address - Phone:404-234-0112
Mailing Address - Fax:404-264-1470
Practice Address - Street 1:455 E PACES FERRY RD NE STE 201
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30305-3319
Practice Address - Country:US
Practice Address - Phone:404-234-0112
Practice Address - Fax:404-264-1470
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-22
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA200106H00000X
GA229101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA14103695OtherCAQH