Provider Demographics
NPI:1629720230
Name:MANN, FATIMA (LMFT)
Entity Type:Individual
Prefix:
First Name:FATIMA
Middle Name:
Last Name:MANN
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1357 LONG ACRE DR
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31204-4252
Mailing Address - Country:US
Mailing Address - Phone:478-337-3456
Mailing Address - Fax:
Practice Address - Street 1:1357 LONG ACRE DR
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31204-4252
Practice Address - Country:US
Practice Address - Phone:478-337-3456
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-25
Last Update Date:2022-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMFT0001736106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty