Provider Demographics
NPI:1346927803
Name:LONDONO, MARIA FERNANDA (LCSW)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:FERNANDA
Last Name:LONDONO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11500 ATLANTIS PL STE C5
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30022-1193
Mailing Address - Country:US
Mailing Address - Phone:678-487-9776
Mailing Address - Fax:678-825-2564
Practice Address - Street 1:11500 ATLANTIS PL STE C5
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30022-1193
Practice Address - Country:US
Practice Address - Phone:678-487-9776
Practice Address - Fax:678-825-2564
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-28
Last Update Date:2023-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0074721041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical