Provider Demographics
NPI:1053834572
Name:MEACHUM, ELIZABETH JOHNSON (LCSW)
Entity type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:JOHNSON
Last Name:MEACHUM
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:KAYE
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4269 KEARNY LN
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22033-4293
Mailing Address - Country:US
Mailing Address - Phone:352-246-1521
Mailing Address - Fax:
Practice Address - Street 1:3060 ROYAL BLVD S STE 210
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30022-1443
Practice Address - Country:US
Practice Address - Phone:470-839-5540
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-18
Last Update Date:2025-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0061791041C0700X
VA09040179581041C0700X
FL141171041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLSW14117OtherLCSW
VA0904017958OtherLCSW LICENSE
GACSW006179OtherLCSW LICENSE