Provider Demographics
NPI:1811421522
Name:SJOGREN, HEATHER CHRISTIANNE (LCSW)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:CHRISTIANNE
Last Name:SJOGREN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:CHRISTI
Other - Middle Name:
Other - Last Name:SJOGREN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:159 BROOKS LAKE DR
Mailing Address - Street 2:
Mailing Address - City:NEWNAN
Mailing Address - State:GA
Mailing Address - Zip Code:30263-5793
Mailing Address - Country:US
Mailing Address - Phone:770-304-6716
Mailing Address - Fax:
Practice Address - Street 1:2 1/2 E COURT SQ
Practice Address - Street 2:SUITE 6
Practice Address - City:NEWNAN
Practice Address - State:GA
Practice Address - Zip Code:30263-2035
Practice Address - Country:US
Practice Address - Phone:770-304-6716
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-19
Last Update Date:2017-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0060311041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical