Healthcare Provider Details

I. General information

NPI: 1528673860
Provider Name (Legal Business Name): DEBBY L LAZARINE LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2020
Last Update Date: 09/17/2025
Certification Date: 09/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9757 BLUE RIDGE DR
BLUE RIDGE GA
30513-4167
US

IV. Provider business mailing address

138 SMOKESTACK RDG
FAIRMOUNT GA
30139-4532
US

V. Phone/Fax

Practice location:
  • Phone: 706-455-2490
  • Fax:
Mailing address:
  • Phone: 706-851-4030
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW007298
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: