Provider Demographics
NPI:1932864618
Name:BOBO, JACQUELINE CIERRA (LMSW)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:CIERRA
Last Name:BOBO
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2608 GLENBROOK LN
Mailing Address - Street 2:
Mailing Address - City:CONYERS
Mailing Address - State:GA
Mailing Address - Zip Code:30012-3696
Mailing Address - Country:US
Mailing Address - Phone:662-816-2969
Mailing Address - Fax:
Practice Address - Street 1:2608 GLENBROOK LN
Practice Address - Street 2:
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30012-3696
Practice Address - Country:US
Practice Address - Phone:662-816-2969
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-08
Last Update Date:2021-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSMSW0079701041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical