Individual
CYNTHIA BACON-WHITTED
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
6200 RIVEROAK TER, COLLEGE PARK, GA 30349-4095
(404) 483-0577
Mailing address
PO BOX 162391, ATLANTA, GA 30321-2391
(404) 483-0577
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
MSW002077
GA
1041C0700X
Clinical Social Worker
CSW005945
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000849032A
—
GA
Enumeration date
12/18/2006
Last updated
01/19/2017
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