Provider Demographics
NPI:1447985015
Name:BOURLAND, CAITLIN ADRIANNA (APC)
Entity type:Individual
Prefix:MRS
First Name:CAITLIN
Middle Name:ADRIANNA
Last Name:BOURLAND
Suffix:
Gender:F
Credentials:APC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1311 HOSEA L WILLIAMS DR SE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30317-1701
Mailing Address - Country:US
Mailing Address - Phone:478-973-3016
Mailing Address - Fax:
Practice Address - Street 1:4200 NORTHSIDE PKWY NW
Practice Address - Street 2:BUILDING 14, SUITE 100
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30327-3007
Practice Address - Country:US
Practice Address - Phone:770-726-9589
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-19
Last Update Date:2022-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAPC008254101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health