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General NPI Number Information
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NPI Number | 1215260153
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Entity Type | Organization
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Legal Business Name | DONNA BRUCKNER, LCSW, LLC
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Dates
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Enumeration Date | 09/10/2009
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Last Update Date | 09/10/2009
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Provider Practice Location Address
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Address Line | 4321 ATLANTA ST
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City | POWDER SPRINGS
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State | GA
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Zip | 30127-2672
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Country | US
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Telephone | 770-943-8277
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Fax |
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Provider Business Mailing Address
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Address Line | 2223 LASALLE DR
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City | MARIETTA
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State | GA
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Zip | 30062-8149
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Country | US
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Telephone | 770-645-6393
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Fax |
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Authorized Official
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Title or Position | OWNER/CLINICAL SOCIAL WORKER
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Name | MRS. DONNA BRUCKNER
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Credential | L.C.S.W.
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Telephone | 770-645-6393
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | CSW003290
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License Number State | GA
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