Provider Demographics
NPI:1962294652
Name:WEAVER, TRISHA KENT (LCSW)
Entity type:Individual
Prefix:MS
First Name:TRISHA
Middle Name:KENT
Last Name:WEAVER
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 1:5977 CLARK RD
Mailing Address - Street 2:
Mailing Address - City:CLERMONT
Mailing Address - State:GA
Mailing Address - Zip Code:30527-1920
Mailing Address - Country:US
Mailing Address - Phone:770-490-0574
Mailing Address - Fax:
Practice Address - Street 1:11340 LAKEFIELD DR STE 200
Practice Address - Street 2:
Practice Address - City:JOHNS CREEK
Practice Address - State:GA
Practice Address - Zip Code:30097-2456
Practice Address - Country:US
Practice Address - Phone:770-490-0574
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-20
Last Update Date:2025-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0094731041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical