Provider Demographics
NPI:1023454105
Name:BUFFALOE, FAYE ANN (CAC II, CCS)
Entity type:Individual
Prefix:
First Name:FAYE
Middle Name:ANN
Last Name:BUFFALOE
Suffix:
Gender:F
Credentials:CAC II, CCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4854 OLD NATIONAL HWY
Mailing Address - Street 2:SUITE 226
Mailing Address - City:COLLEGE PARK
Mailing Address - State:GA
Mailing Address - Zip Code:30337-6221
Mailing Address - Country:US
Mailing Address - Phone:404-312-7862
Mailing Address - Fax:770-774-1039
Practice Address - Street 1:4854 OLD NATIONAL HWY
Practice Address - Street 2:SUITE 226
Practice Address - City:COLLEGE PARK
Practice Address - State:GA
Practice Address - Zip Code:30337-6221
Practice Address - Country:US
Practice Address - Phone:404-312-7862
Practice Address - Fax:770-774-1039
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-16
Last Update Date:2013-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)