Provider Demographics
NPI:1033230495
Name:BOGARTZ, BARBARA ANN (LPC)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:ANN
Last Name:BOGARTZ
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2235 SIX BRANCHES DR
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30076-3044
Mailing Address - Country:US
Mailing Address - Phone:770-992-2605
Mailing Address - Fax:770-642-4239
Practice Address - Street 1:490 SUN VALLEY DR
Practice Address - Street 2:SUITE205
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30076-5615
Practice Address - Country:US
Practice Address - Phone:770-642-4236
Practice Address - Fax:770-642-4239
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA002825101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional