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General NPI Number Information
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NPI Number | 1639589179
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Entity Type | Organization
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Legal Business Name | SUE HOWELL-FAFCHAMPS LCSW LLC
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Dates
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Enumeration Date | 05/06/2014
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Last Update Date | 05/06/2014
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Provider Practice Location Address
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Address Line | 3711 EXECUTIVE CENTER DR SUITE 202 OFFICE 1
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City | MARTINEZ
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State | GA
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Zip | 30907-0951
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Country | US
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Telephone | 803-719-2190
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Fax | 706-432-9095
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Provider Business Mailing Address
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Address Line | 3711 EXECUTIVE CENTER DR SUITE 202 OFFICE 1
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City | MARTINEZ
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State | GA
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Zip | 30907-0951
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Country | US
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Telephone | 803-719-2190
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Fax | 706-432-9095
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Authorized Official
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Title or Position | SOLE OWNER/MEMBER
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Name | MS. SUE HOWELL-FAFCHAMPS
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Credential | LCSW
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Telephone | 803-719-2190
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | CSW004238
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License Number State | GA
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