Healthcare Provider Details

I. General information

NPI: 1891855037
Provider Name (Legal Business Name): CHRISTINA S. DYER LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/11/2006
Last Update Date: 09/19/2024
Certification Date: 09/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 FREEDOM WAY (28)
AUGUSTA GA
30904
US

IV. Provider business mailing address

3421 MIKE PADGETT HWY
AUGUSTA GA
30906-3815
US

V. Phone/Fax

Practice location:
  • Phone: 706-733-0188
  • Fax:
Mailing address:
  • Phone: 706-432-4858
  • Fax: 706-432-3780

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW005841
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: