Basic Information
| Provider Information | |||||||||
| NPI: | 1174738116 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | TEDOFF | ||||||||
| FirstName: | VICTOR | ||||||||
| MiddleName: | ALVIN | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1200 CAROL LN NE | ||||||||
| Address2: | |||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303062208 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4042943835 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2751 BUFORD HWY NE | ||||||||
| Address2: | STE 204 | ||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303245456 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4046060436 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/12/2007 | ||||||||
| LastUpdateDate: | 07/05/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | CSW002477 | GA | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.