Provider Demographics
NPI:1962845818
Name:BEATTIE, ALISA FAYE (LCSW)
Entity type:Individual
Prefix:MRS
First Name:ALISA
Middle Name:FAYE
Last Name:BEATTIE
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 1:11675 BENTHAM CT
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30005-8940
Mailing Address - Country:US
Mailing Address - Phone:404-271-3641
Mailing Address - Fax:
Practice Address - Street 1:901 BOMBAY LN
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30076-5829
Practice Address - Country:US
Practice Address - Phone:770-664-1920
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-10
Last Update Date:2013-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0029951041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical