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General NPI Number Information
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NPI Number | 1992110597
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Entity Type | Individual
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Provider Name | OCTAVIA FAULK LMSW, ED.S
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Gender | Female
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Dates
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Enumeration Date | 06/23/2014
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Last Update Date | 12/16/2023
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Provider Practice Location Address
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Address Line | 1592 NORMAN DR
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City | VALDOSTA
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State | GA
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Zip | 31601-3581
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Country | US
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Telephone | 229-300-7480
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Fax |
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Provider Business Mailing Address
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Address Line | 105 WYOMING ST
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City | ADEL
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State | GA
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Zip | 31620-5214
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Country | US
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Telephone | 229-300-7480
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | MSW010634
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License Number State | GA
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