Provider Demographics
NPI:1497907174
Name:IDIGO, CLAUDETTE M (LCSW)
Entity Type:Individual
Prefix:MS
First Name:CLAUDETTE
Middle Name:M
Last Name:IDIGO
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 1:101 SAN MARINO CT
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30214-1435
Mailing Address - Country:US
Mailing Address - Phone:678-428-1728
Mailing Address - Fax:678-523-2351
Practice Address - Street 1:101 SAN MARINO CT
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30214-1435
Practice Address - Country:US
Practice Address - Phone:678-723-4448
Practice Address - Fax:678-528-2351
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-14
Last Update Date:2017-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0040181041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GACSW0004018OtherPROFESSIONAL STATE LICENSURE