1093017113 NPI number — SABRINA DUTCH FALKENHAGEN LCSW

Table of content: SABRINA DUTCH FALKENHAGEN LCSW (NPI 1093017113)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093017113 NPI number — SABRINA DUTCH FALKENHAGEN LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FALKENHAGEN
Provider First Name:
SABRINA
Provider Middle Name:
DUTCH
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
DUTCH
Provider Other First Name:
SABRINA
Provider Other Middle Name:
STANFORD
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
LCSW
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1093017113
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/23/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
134 CATHY LN NE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CALHOUN
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30701-4972
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
770-548-8737
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1124 N. TENNESEE ST.
Provider Second Line Business Practice Location Address:
SUITE 104
Provider Business Practice Location Address City Name:
CARTERSVILLE
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30120
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
770-607-7310
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/22/2010

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  CSW001813 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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