Provider Demographics
NPI:1932240389
Name:DENNARD, LINDA G (LCSW)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:G
Last Name:DENNARD
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 1:5438 REDWOOD CT
Mailing Address - Street 2:
Mailing Address - City:STONE MOUNTAIN
Mailing Address - State:GA
Mailing Address - Zip Code:30087-5758
Mailing Address - Country:US
Mailing Address - Phone:770-413-9641
Mailing Address - Fax:770-413-9641
Practice Address - Street 1:5438 REDWOOD CT
Practice Address - Street 2:
Practice Address - City:STONE MOUNTAIN
Practice Address - State:GA
Practice Address - Zip Code:30087-5758
Practice Address - Country:US
Practice Address - Phone:770-413-9641
Practice Address - Fax:770-413-9641
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-09
Last Update Date:2014-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0026711041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA202I802569Medicare PIN