Provider Demographics
NPI:1679244750
Name:BERMUDEZ, CHRISTINE (MA)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:
Last Name:BERMUDEZ
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:508 PHILADELPHIA LN
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:GA
Mailing Address - Zip Code:30189-5213
Mailing Address - Country:US
Mailing Address - Phone:404-454-6559
Mailing Address - Fax:
Practice Address - Street 1:4411 SUWANEE DAM RD STE 720
Practice Address - Street 2:
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-8708
Practice Address - Country:US
Practice Address - Phone:678-993-8494
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-28
Last Update Date:2021-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional