Healthcare Provider Details

I. General information

NPI: 1902469539
Provider Name (Legal Business Name): LINDSEY RADABAUGH LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/18/2019
Last Update Date: 04/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1414 DUG GAP RD
DALTON GA
30720-5007
US

IV. Provider business mailing address

210 EMERALD LN
MINERAL BLUFF GA
30559-2927
US

V. Phone/Fax

Practice location:
  • Phone: 706-279-0405
  • Fax:
Mailing address:
  • Phone: 770-289-5528
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW005768
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: