Provider Demographics
NPI:1033434907
Name:HOWELL-FAFCHAMPS, SUE (LCSW, LMSW,LISW-CP)
Entity Type:Individual
Prefix:MS
First Name:SUE
Middle Name:
Last Name:HOWELL-FAFCHAMPS
Suffix:
Gender:F
Credentials:LCSW, LMSW,LISW-CP
Other - Prefix:MS
Other - First Name:SUSAN
Other - Middle Name:
Other - Last Name:HOWELL-FAFCHAMPS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW, LMSW, LISW-CP
Mailing Address - Street 1:3711 EXECUTIVE CENTER DR
Mailing Address - Street 2:SUITE 201
Mailing Address - City:MARTINEZ
Mailing Address - State:GA
Mailing Address - Zip Code:30907-0951
Mailing Address - Country:US
Mailing Address - Phone:706-868-5011
Mailing Address - Fax:796-868-5023
Practice Address - Street 1:3711 EXECUTIVE CENTER DR
Practice Address - Street 2:SUITE 201
Practice Address - City:MARTINEZ
Practice Address - State:GA
Practice Address - Zip Code:30907-0951
Practice Address - Country:US
Practice Address - Phone:706-868-5011
Practice Address - Fax:706-868-5023
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-02
Last Update Date:2014-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW004238104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA202I803969Medicare PIN