Provider Demographics
NPI:1538393442
Name:BOIVIN, JUDITH MARIE (RN,LCSW, ACSW)
Entity type:Individual
Prefix:
First Name:JUDITH
Middle Name:MARIE
Last Name:BOIVIN
Suffix:
Gender:F
Credentials:RN,LCSW, ACSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 LAKEVIEW DR
Mailing Address - Street 2:
Mailing Address - City:TURTLETOWN
Mailing Address - State:TN
Mailing Address - Zip Code:37391-4815
Mailing Address - Country:US
Mailing Address - Phone:423-548-6372
Mailing Address - Fax:
Practice Address - Street 1:101 RIVERSTONE VIS
Practice Address - Street 2:
Practice Address - City:BLUE RIDGE
Practice Address - State:GA
Practice Address - Zip Code:30513-6648
Practice Address - Country:US
Practice Address - Phone:706-851-6019
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-06
Last Update Date:2009-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0022221041C0700X
GA130664163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No163W00000XNursing Service ProvidersRegistered Nurse