Provider Demographics
NPI:1093129561
Name:BODEN, BRITTANY (LCSW, CGP)
Entity Type:Individual
Prefix:
First Name:BRITTANY
Middle Name:
Last Name:BODEN
Suffix:
Gender:F
Credentials:LCSW, CGP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2801 BUFORD HWY NE
Mailing Address - Street 2:SUITE 470
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30329-2149
Mailing Address - Country:US
Mailing Address - Phone:678-429-4833
Mailing Address - Fax:404-321-1928
Practice Address - Street 1:2801 BUFORD HWY NE
Practice Address - Street 2:SUITE 470
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30329-2149
Practice Address - Country:US
Practice Address - Phone:678-429-4833
Practice Address - Fax:404-321-1928
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-12
Last Update Date:2014-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0041731041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical