Healthcare Provider Details

I. General information

NPI: 1073514725
Provider Name (Legal Business Name): DEBBIE DUNBAR LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 08/03/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2710 JEFFERSON ST SUITE 6
AUSTELL GA
30168-4050
US

IV. Provider business mailing address

2710 JEFFERSON ST SUITE 6
AUSTELL GA
30168-4050
US

V. Phone/Fax

Practice location:
  • Phone: 770-732-0190
  • Fax: 770-732-0333
Mailing address:
  • Phone: 770-732-0190
  • Fax: 770-732-0333

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number1536
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: