Provider Demographics
NPI:1053345058
Name:LEBEAUX, MONA (LCSW)
Entity type:Individual
Prefix:MS
First Name:MONA
Middle Name:
Last Name:LEBEAUX
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 1:2791 CLAIRMONT RD NE
Mailing Address - Street 2:STE 127
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30329-2744
Mailing Address - Country:US
Mailing Address - Phone:404-636-8060
Mailing Address - Fax:678-377-9708
Practice Address - Street 1:2791 CLAIRMONT RD NE
Practice Address - Street 2:STE 127
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30329-2744
Practice Address - Country:US
Practice Address - Phone:404-636-8060
Practice Address - Fax:678-377-9708
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0011981041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GABBBFQCMedicare ID - Type Unspecified