Provider Demographics
NPI:1730520925
Name:FAW SERVICES , LLC
Entity type:Organization
Organization Name:FAW SERVICES , LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, SOLE PROPRIETOR
Authorized Official - Prefix:DR
Authorized Official - First Name:FELICIA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:WHITEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, MD
Authorized Official - Phone:985-264-1501
Mailing Address - Street 1:223 BELLINGRATH PL
Mailing Address - Street 2:
Mailing Address - City:MADISONVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70447-3421
Mailing Address - Country:US
Mailing Address - Phone:985-264-1501
Mailing Address - Fax:
Practice Address - Street 1:223 BELLINGRATH PL
Practice Address - Street 2:
Practice Address - City:MADISONVILLE
Practice Address - State:LA
Practice Address - Zip Code:70447-3421
Practice Address - Country:US
Practice Address - Phone:985-264-1501
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-16
Last Update Date:2013-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMP.0007103TP0016X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TP0016XBehavioral Health & Social Service ProvidersPsychologistPrescribing (Medical)Group - Single Specialty