Healthcare Provider Details

I. General information

NPI: 1588914253
Provider Name (Legal Business Name): APRINA BROADNAX-MCCUTCHEON LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: APRINA BROADNAX LCSW

II. Dates (important events)

Enumeration Date: 09/10/2012
Last Update Date: 03/29/2022
Certification Date: 03/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3650 STEVE REYNOLDS BLVD
DULUTH GA
30096-4506
US

IV. Provider business mailing address

3495 PIEDMONT RD NE BLDG 9 1ST FLOOR
ATLANTA GA
30305-1736
US

V. Phone/Fax

Practice location:
  • Phone: 770-921-8477
  • Fax:
Mailing address:
  • Phone: 404-364-7285
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW004703
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: