Healthcare Provider Details

I. General information

NPI: 1174813331
Provider Name (Legal Business Name): APRIL ELIZABETH FALLON LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/08/2011
Last Update Date: 04/08/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2557 GADSEN WALK
DULUTH GA
30097-4349
US

IV. Provider business mailing address

2557 GADSEN WALK
DULUTH GA
30097-4349
US

V. Phone/Fax

Practice location:
  • Phone: 404-403-2701
  • Fax:
Mailing address:
  • Phone: 404-403-2701
  • Fax: 770-813-9001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW004065
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: