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General NPI Number Information
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NPI Number | 1386085280
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Entity Type | Organization
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Legal Business Name | KBOGGSPC
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Dates
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Enumeration Date | 07/09/2013
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Last Update Date | 07/09/2013
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Provider Practice Location Address
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Address Line | 5435 SUGARLOAF PKWY SUITE 1104
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City | LAWRENCEVILLE
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State | GA
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Zip | 30043
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Country | US
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Telephone | 678-358-6200
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Fax |
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Provider Business Mailing Address
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Address Line | 4602 SEQUOIA CIR
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City | OAKWOOD
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State | GA
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Zip | 30566-2129
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Country | US
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Telephone | 678-358-6200
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | KATHERINE BOGGS
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Credential | LCSW
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Telephone | 678-358-6200
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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 | CSW001288
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License Number State | GA
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