=====================================================
General NPI Number Information
=====================================================
NPI Number | 1619438595
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | FAYE DORIS WEEMS-SINGLETON LMFT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/25/2019
-----------------------------------------------------
Last Update Date | 03/25/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3000 LANGFORD RD / BUILDING 300
-----------------------------------------------------
City | NORCROSS
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30071-4772
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 850-999-0940
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3000 LANGFORD RD / BUILDING 300
-----------------------------------------------------
City | NORCROSS
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30071-4772
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 850-999-0940
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number | MFT001587
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------