Individual
BEVONNA TRAIL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
6470 E JOHNS XING, JOHNS CREEK, GA 30097-2511
(470) 588-2692
Mailing address
6470 EAST JOHNS CROSSING, PMB 920146, PEACHTREE CORNERS, GA 30097
(470) 588-2692
(866) 560-1337
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
096547
NY
1041C0700X
Clinical Social Worker
Primary
CSW008493
GA
1041C0700X
Clinical Social Worker
LICSW1121247
MA
Other
Enumeration date
12/04/2017
Last updated
03/11/2026
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