Healthcare Provider Details

I. General information

NPI: 1033895008
Provider Name (Legal Business Name): BRITTANY MARIE TALKIN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/26/2023
Last Update Date: 02/29/2024
Certification Date: 02/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1077 WILLIS GLENN RD
HULL GA
30646
US

IV. Provider business mailing address

1077 WILLIS GLENN RD
HULL GA
30646
US

V. Phone/Fax

Practice location:
  • Phone: 706-201-9455
  • Fax:
Mailing address:
  • Phone: 706-201-9455
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number008161
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW008958
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: