Provider Demographics
NPI:1194064154
Name:WEBB, ANASTACIA SP (LMFT)
Entity type:Individual
Prefix:
First Name:ANASTACIA
Middle Name:SP
Last Name:WEBB
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:ANASTACIA
Other - Middle Name:
Other - Last Name:DELVALLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:333 THE GABLES DR
Mailing Address - Street 2:
Mailing Address - City:MCDONOUGH
Mailing Address - State:GA
Mailing Address - Zip Code:30253-7460
Mailing Address - Country:US
Mailing Address - Phone:706-284-9016
Mailing Address - Fax:
Practice Address - Street 1:5887 GLENRIDGE DR STE 230
Practice Address - Street 2:
Practice Address - City:SANDY SPRINGS
Practice Address - State:GA
Practice Address - Zip Code:30328-9929
Practice Address - Country:US
Practice Address - Phone:706-920-2256
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-11
Last Update Date:2023-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAMFT000231101YM0800X
GAMFT001385101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000606317BMedicaid
GA000606317BMedicaid