Individual
EBONY C BOOKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
135 ALICANTE ST, COLLEGE PARK, GA 30349-8493
(404) 707-5743
Mailing address
135 ALICANTE ST, COLLEGE PARK, GA 30349-8493
(404) 707-5743
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
CSW006762
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
NONE
NONE
—
Enumeration date
09/03/2020
Last updated
09/03/2020
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