Provider Demographics
NPI:1851004758
Name:BELLINGER, BREEANNA (LMSW)
Entity Type:Individual
Prefix:
First Name:BREEANNA
Middle Name:
Last Name:BELLINGER
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:BREEANNA
Other - Middle Name:
Other - Last Name:USHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:380 SHELTON WOODS CT
Mailing Address - Street 2:
Mailing Address - City:STONE MOUNTAIN
Mailing Address - State:GA
Mailing Address - Zip Code:30088-1144
Mailing Address - Country:US
Mailing Address - Phone:310-309-7194
Mailing Address - Fax:
Practice Address - Street 1:175 GWINNETT DR
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30046-8444
Practice Address - Country:US
Practice Address - Phone:678-209-2394
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-05
Last Update Date:2023-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMSW008323104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker