Provider Demographics
NPI:1255094918
Name:BROOKRESON OWENS, KARLA STREETER (LCSW)
Entity Type:Individual
Prefix:
First Name:KARLA
Middle Name:STREETER
Last Name:BROOKRESON OWENS
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:PO BOX D
Mailing Address - Street 2:
Mailing Address - City:TOCCOA
Mailing Address - State:GA
Mailing Address - Zip Code:30577-1448
Mailing Address - Country:US
Mailing Address - Phone:706-244-5159
Mailing Address - Fax:706-886-2265
Practice Address - Street 1:768 HIGHWAY 123
Practice Address - Street 2:
Practice Address - City:TOCCOA
Practice Address - State:GA
Practice Address - Zip Code:30577-8686
Practice Address - Country:US
Practice Address - Phone:706-244-5159
Practice Address - Fax:706-886-2265
Is Sole Proprietor?:No
Enumeration Date:2021-10-20
Last Update Date:2022-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0076951041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical