Healthcare Provider Details

I. General information

NPI: 1518052109
Provider Name (Legal Business Name): DEBORAH P. WAKEFIELD LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4607 PINEHURST COURT HEPHZIBAH, GA 30815 VA MEDICAL CENTER 1 FREEDOM WAY
AUGUSTA GA
30904
US

IV. Provider business mailing address

4607 PINEHURST COURT
HEPHZIBAH GA
30815
US

V. Phone/Fax

Practice location:
  • Phone: 706-733-0188
  • Fax:
Mailing address:
  • Phone: 706-592-1327
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW001947
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: