Provider Demographics
NPI:1194476952
Name:METRAKOUDES-HEWETT, HEIDI R (LCSW)
Entity type:Individual
Prefix:
First Name:HEIDI
Middle Name:R
Last Name:METRAKOUDES-HEWETT
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:HEIDI
Other - Middle Name:
Other - Last Name:HEWETT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:590 HOLMAN AVE
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30606-2626
Mailing Address - Country:US
Mailing Address - Phone:706-372-6122
Mailing Address - Fax:
Practice Address - Street 1:3722 ATLANTA HWY STE 4
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30606-1862
Practice Address - Country:US
Practice Address - Phone:470-236-8584
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-13
Last Update Date:2023-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0087971041C0700X
GAMSW009783104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical