Healthcare Provider Details

I. General information

NPI: 1215143292
Provider Name (Legal Business Name): SUE ANNE LASSIN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2007
Last Update Date: 08/07/2026
Certification Date: 08/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1826 VETERANS BLVD
DUBLIN GA
31021-3631
US

IV. Provider business mailing address

644 SKIPPER JACKSON RD
COCHRAN GA
31014-2547
US

V. Phone/Fax

Practice location:
  • Phone: 478-277-1600
  • Fax:
Mailing address:
  • Phone: 352-888-0286
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW004573
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: