Healthcare Provider Details

I. General information

NPI: 1548613508
Provider Name (Legal Business Name): CALANDRA JOHNSON TOGBA-DOYA LCSW, LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2016
Last Update Date: 05/22/2023
Certification Date: 05/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

733 KIOWA DR NE
MARIETTA GA
30060-7223
US

IV. Provider business mailing address

733 KIOWA DR NE
MARIETTA GA
30060-7223
US

V. Phone/Fax

Practice location:
  • Phone: 706-389-4198
  • Fax:
Mailing address:
  • Phone: 706-389-4198
  • Fax: 770-693-0157

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberCSW006020
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number200002488
License Number StateDC
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW006020
License Number StateGA
# 4
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number006020
License Number StateGA
# 5
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number126335
License Number StateMA
# 6
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0904014551
License Number StateVA
# 7
Primary TaxonomyN
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number1381360
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: