Provider Demographics
NPI:1598933368
Name:BOOKER, BRENDA J (LCSW)
Entity Type:Individual
Prefix:MS
First Name:BRENDA
Middle Name:J
Last Name:BOOKER
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 1:125 BELLE GATE DR
Mailing Address - Street 2:
Mailing Address - City:POOLER
Mailing Address - State:GA
Mailing Address - Zip Code:31322-9735
Mailing Address - Country:US
Mailing Address - Phone:217-836-2015
Mailing Address - Fax:912-335-5678
Practice Address - Street 1:7370 HODGSON MEMORIAL DR STE C1
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31406-2540
Practice Address - Country:US
Practice Address - Phone:912-344-9401
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-14
Last Update Date:2019-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0054131041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical