Provider Demographics
NPI:1598113276
Name:BODDY, CRESTRE MERITA (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:CRESTRE
Middle Name:MERITA
Last Name:BODDY
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 1:3330 CUMBERLAND BLVD SE STE 500
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30339-5997
Mailing Address - Country:US
Mailing Address - Phone:770-933-6222
Mailing Address - Fax:404-228-6597
Practice Address - Street 1:3330 CUMBERLAND BLVD SE STE 500
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30339-5997
Practice Address - Country:US
Practice Address - Phone:770-933-6222
Practice Address - Fax:404-228-6597
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-02
Last Update Date:2016-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0057821041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical