Provider Demographics
NPI:1578872867
Name:BOOKMAN, DAYAN CARLA
Entity Type:Individual
Prefix:MRS
First Name:DAYAN
Middle Name:CARLA
Last Name:BOOKMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2046 WEDGEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:STONE MOUNTAIN
Mailing Address - State:GA
Mailing Address - Zip Code:30088-3941
Mailing Address - Country:US
Mailing Address - Phone:310-844-5629
Mailing Address - Fax:
Practice Address - Street 1:6624 JIMMY CARTER BLVD STE A
Practice Address - Street 2:
Practice Address - City:PEACHTREE CORNERS
Practice Address - State:GA
Practice Address - Zip Code:30071-1727
Practice Address - Country:US
Practice Address - Phone:404-900-5450
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-04
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA689151041C0700X
GACSW0063421041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical