Provider Demographics
NPI:1013422237
Name:VERBRUGGE, BETHANY (LCSW)
Entity Type:Individual
Prefix:
First Name:BETHANY
Middle Name:
Last Name:VERBRUGGE
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 1:2440 SANDY PLAINS RD BLDG 26
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30066-7218
Mailing Address - Country:US
Mailing Address - Phone:616-594-0842
Mailing Address - Fax:
Practice Address - Street 1:2440 SANDY PLAINS RD BLDG 26
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30066-7218
Practice Address - Country:US
Practice Address - Phone:616-594-0842
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-11
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0089481041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical