Healthcare Provider Details

I. General information

NPI: 1326149550
Provider Name (Legal Business Name): REBEKAH HUFFMAN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/26/2006
Last Update Date: 10/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

85 GOLF CREST DRIVE
ACWORTH GA
30101
US

IV. Provider business mailing address

19 SNAP DRAGON CIRCLE
DALLAS GA
30132
US

V. Phone/Fax

Practice location:
  • Phone: 404-402-5774
  • Fax:
Mailing address:
  • Phone: 404-402-5774
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW003653
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: