Individual
MRS. CHASTIDY BOUTIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1817 GREEN CIR, VALDOSTA, GA 31602-2885
(229) 244-9688
Mailing address
1817 GREEN CIR, VALDOSTA, GA 31602-2885
(229) 244-9688
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
CSW009362
GA
1041C0700X
Clinical Social Worker
—
—
Other
Enumeration date
11/15/2021
Last updated
01/07/2025
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