Healthcare Provider Details

I. General information

NPI: 1144692286
Provider Name (Legal Business Name): NITEIKA LACOLE SNEED LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/28/2015
Last Update Date: 10/28/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3711 EXECUTIVE CENTER DR SUITE 201
MARTINEZ GA
30907-0951
US

IV. Provider business mailing address

3711 EXECUTIVE CENTER DR SUITE 201
MARTINEZ GA
30907-0951
US

V. Phone/Fax

Practice location:
  • Phone: 706-868-5011
  • Fax: 706-868-5023
Mailing address:
  • Phone: 706-868-5011
  • Fax: 706-868-5023

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberMSW005593
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: