Provider Demographics
NPI:1588027585
Name:BABA, KATIE (MSW)
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:
Last Name:BABA
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1011 WOODRIDGE LN
Mailing Address - Street 2:SUITE 201
Mailing Address - City:WATKINSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30677-6077
Mailing Address - Country:US
Mailing Address - Phone:706-715-3414
Mailing Address - Fax:
Practice Address - Street 1:1011 WOODRIDGE LN
Practice Address - Street 2:SUITE 201
Practice Address - City:WATKINSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30677-6077
Practice Address - Country:US
Practice Address - Phone:706-715-3414
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-29
Last Update Date:2016-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA113959301104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker