Provider Demographics
NPI:1629320072
Name:ALLEN, FURMA SHAUNTEL BEGLEY (LCSW)
Entity Type:Individual
Prefix:
First Name:FURMA
Middle Name:SHAUNTEL BEGLEY
Last Name:ALLEN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:FURMA
Other - Middle Name:SHAUNTEL
Other - Last Name:BEGLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:4210 COLUMBIA RD
Mailing Address - Street 2:STE 13C
Mailing Address - City:MARTINEZ
Mailing Address - State:GA
Mailing Address - Zip Code:30907-0445
Mailing Address - Country:US
Mailing Address - Phone:706-833-9378
Mailing Address - Fax:706-522-9104
Practice Address - Street 1:4210 COLUMBIA RD
Practice Address - Street 2:STE 13C
Practice Address - City:MARTINEZ
Practice Address - State:GA
Practice Address - Zip Code:30907-0445
Practice Address - Country:US
Practice Address - Phone:706-833-9378
Practice Address - Fax:706-522-9104
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-10
Last Update Date:2016-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMSW004665104100000X
104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003164181AMedicaid