Individual
MRS. CASEY MINTZ BEISE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
1479 BROCKETT RD STE 100, TUCKER, GA 30084-7326
(770) 375-8124
Mailing address
1479 BROCKETT RD STE 100, TUCKER, GA 30084-7326
(770) 375-8124
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
CSW006556
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CSW006556
GEORGIA COMPOSITE BOARD OF PC, SW, AND MFT CLINICAL SOCIAL WORKER
GA
Enumeration date
11/04/2018
Last updated
11/04/2018
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