Provider Demographics
NPI:1861745580
Name:CALLOWAY, NANCY EYVONNE (LCSW)
Entity type:Individual
Prefix:MS
First Name:NANCY
Middle Name:EYVONNE
Last Name:CALLOWAY
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 1:11440 VINEA WAY
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:GA
Mailing Address - Zip Code:30228-6258
Mailing Address - Country:US
Mailing Address - Phone:404-345-0701
Mailing Address - Fax:
Practice Address - Street 1:2591 CANDLER RD
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30032-6502
Practice Address - Country:US
Practice Address - Phone:678-209-2710
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-18
Last Update Date:2012-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0036681041C0700X
GA40434507011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical