Provider Demographics
NPI:1982925251
Name:FAULK, GENEVIEVE G (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:GENEVIEVE
Middle Name:G
Last Name:FAULK
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 1:9270 BAY PLAZA BLVD
Mailing Address - Street 2:604
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33619-4499
Mailing Address - Country:US
Mailing Address - Phone:813-246-4120
Mailing Address - Fax:813-246-4194
Practice Address - Street 1:9270 BAY PLAZA BLVD
Practice Address - Street 2:604
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33619-4499
Practice Address - Country:US
Practice Address - Phone:813-246-4120
Practice Address - Fax:813-246-4194
Is Sole Proprietor?:No
Enumeration Date:2010-06-21
Last Update Date:2010-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW83071041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical