Healthcare Provider Details

I. General information

NPI: 1285575951
Provider Name (Legal Business Name): JUDE CYPRIEN LOUISSAINT LMSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/04/2026
Last Update Date: 04/04/2026
Certification Date: 04/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 LONGWOOD PL
DALLAS GA
30132-1011
US

IV. Provider business mailing address

120 LONGWOOD PL
DALLAS GA
30132-1011
US

V. Phone/Fax

Practice location:
  • Phone: 407-963-3293
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberMSW012927
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: