Individual
MS. CLAUDETTE M IDIGO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
101 SAN MARINO CT, FAYETTEVILLE, GA 30214-1435
(678) 723-4448
(678) 528-2351
Mailing address
101 SAN MARINO CT, FAYETTEVILLE, GA 30214-1435
(678) 428-1728
(678) 523-2351
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
CSW004018
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CSW0004018
PROFESSIONAL STATE LICENSURE
GA
Enumeration date
10/14/2008
Last updated
10/13/2017
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