Basic Information
| Provider Information | |||||||||
| NPI: | 1083052849 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SPANN | ||||||||
| FirstName: | LORLITA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | |||||||||
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| Credential: | LCSW-A | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 445 WINN WAY | ||||||||
| Address2: | |||||||||
| City: | DECATUR | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300301707 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4042943745 | ||||||||
| FaxNumber: | 4042943710 | ||||||||
| Practice Location | |||||||||
| Address1: | 445 WINN WAY | ||||||||
| Address2: | |||||||||
| City: | DECATUR | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300301707 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4042943745 | ||||||||
| FaxNumber: | 4042943710 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/13/2013 | ||||||||
| LastUpdateDate: | 10/26/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | P008037 | NC | N | Behavioral Health & Social Service Providers | Social Worker | 1041C0700X | P008037 | NC | N | Behavioral Health & Social Service Providers | Social Worker | Clinical | 1041C0700X | CSW005813 | GA | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.