Provider Demographics
NPI:1245621473
Name:FAHSHAK ENTERPRISES, LLC
Entity type:Organization
Organization Name:FAHSHAK ENTERPRISES, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SUB. ABUSE & ADDICTION THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:VICKIE
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:HILL
Authorized Official - Suffix:
Authorized Official - Credentials:CADCII
Authorized Official - Phone:404-563-5354
Mailing Address - Street 1:3023 CEDAR BROOK DR
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30033-6013
Mailing Address - Country:US
Mailing Address - Phone:404-563-5354
Mailing Address - Fax:
Practice Address - Street 1:3023 CEDAR BROOK DR
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30033-6013
Practice Address - Country:US
Practice Address - Phone:404-563-5354
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-10
Last Update Date:2015-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA818251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health