Provider Demographics
NPI:1245400795
Name:SOUTHWELL, FARAH (MS, LPC, CPCS)
Entity Type:Individual
Prefix:
First Name:FARAH
Middle Name:
Last Name:SOUTHWELL
Suffix:
Gender:F
Credentials:MS, LPC, CPCS
Other - Prefix:
Other - First Name:FARAH
Other - Middle Name:
Other - Last Name:HALABY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1725 PENNSYLVANIA AVE
Mailing Address - Street 2:
Mailing Address - City:MCDONOUGH
Mailing Address - State:GA
Mailing Address - Zip Code:30253-9118
Mailing Address - Country:US
Mailing Address - Phone:678-853-5849
Mailing Address - Fax:
Practice Address - Street 1:1725 PENNSYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:MCDONOUGH
Practice Address - State:GA
Practice Address - Zip Code:30253-9118
Practice Address - Country:US
Practice Address - Phone:678-853-5849
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-11
Last Update Date:2023-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH5568101YM0800X
GALPC010787101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health