Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Creystal Demi Fagbohun, LCSW

Individual provider Clinical Social Worker · NPI 1689408031

Creystal Demi Fagbohun, LCSW is a Clinical Social Worker in Marietta, Georgia. Qualified in 2015, 11 years ago. Practices with Mental Health Specialty Group PA, a 679-clinician group and accepts Medicare assignment. Licensed in Georgia.

Years since qualifying
11
Licensed in
GA
In the registry since
2024
What do these letters mean?
LCSW — Licensed Clinical Social Worker
A social worker licensed to diagnose and treat mental health conditions independently.

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Practice location Address checks out

3126 Rich Rd
Marietta, GA 30066-3802
Phone: (770) 903-2150
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Clinical Social Worker (primary) Taxonomy 1041C0700X · Licence CSW007521 (GA)

Record details

NPI number1689408031
Entity typeIndividual (Type 1)
GenderFemale
Credentials LCSW
Sole proprietorNo
NPI enumeratedAugust 28, 2024
Last updated in NPPESAugust 28, 2024
Certification dateAugust 28, 2024

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyCLINICAL SOCIAL WORKER
Medical schoolOTHER
Graduated 2015 (11 years in practice)
Group practice Mental Health Specialty Group Pa — 679 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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