Provider Demographics
NPI:1588948657
Name:WESTERGARD, SUSAN S (LCSW)
Entity type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:S
Last Name:WESTERGARD
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 1:864 GILBERT ST SE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30316-2478
Mailing Address - Country:US
Mailing Address - Phone:404-545-5820
Mailing Address - Fax:
Practice Address - Street 1:864 GILBERT ST SE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30316-2478
Practice Address - Country:US
Practice Address - Phone:404-545-5820
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-06
Last Update Date:2021-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPTA002090225200000X
GALCSW0043631041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant