Provider Demographics
NPI:1922659192
Name:BOOKER, CHRISTIAN BIANCA
Entity Type:Individual
Prefix:
First Name:CHRISTIAN
Middle Name:BIANCA
Last Name:BOOKER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:944 KINGS BAY RD. #247
Mailing Address - Street 2:
Mailing Address - City:ST. MARYS
Mailing Address - State:GA
Mailing Address - Zip Code:31558
Mailing Address - Country:US
Mailing Address - Phone:912-387-2407
Mailing Address - Fax:912-387-2407
Practice Address - Street 1:944 KINGS BAY RD. #247
Practice Address - Street 2:
Practice Address - City:ST. MARYS
Practice Address - State:GA
Practice Address - Zip Code:31558
Practice Address - Country:US
Practice Address - Phone:912-387-2407
Practice Address - Fax:912-387-2407
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-27
Last Update Date:2019-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0055091041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty