Individual
OCTAVIA FAULK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMSW, ED.S
Contact information
Practice address
1592 NORMAN DR, VALDOSTA, GA 31601-3581
(229) 300-7480
Mailing address
105 WYOMING ST, ADEL, GA 31620-5214
(229) 300-7480
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
MSW010634
GA
Other
Enumeration date
06/23/2014
Last updated
12/16/2023
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