Provider Demographics
NPI:1588690242
Name:THREET, XERSALYN T (LCSW)
Entity type:Individual
Prefix:MISS
First Name:XERSALYN
Middle Name:T
Last Name:THREET
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
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Mailing Address - Street 1:2566 SHALLOWFORD RD NE
Mailing Address - Street 2:SUITE 104-346
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30345-1202
Mailing Address - Country:US
Mailing Address - Phone:770-289-1988
Mailing Address - Fax:770-696-2510
Practice Address - Street 1:1670 CLAIRMONT RD
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30033-4004
Practice Address - Country:US
Practice Address - Phone:404-321-6111
Practice Address - Fax:404-728-4703
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GACSW0035581041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical