Healthcare Provider Details

I. General information

NPI: 1225072572
Provider Name (Legal Business Name): THEBA SUZETTE HUGGINS LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2006
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1870 THE EXCHANGE SE STE 200
ATLANTA GA
30339-2021
US

IV. Provider business mailing address

4045 BRIGHTMORE DR
AUSTELL GA
30106-4630
US

V. Phone/Fax

Practice location:
  • Phone: 404-558-3297
  • Fax:
Mailing address:
  • Phone: 404-321-6111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW005491
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801081714
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: