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General NPI Number Information
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NPI Number | 1508675745
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Entity Type | Individual
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Provider Name | CHANNELLE LAVONNE REFUGE LMSW
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Gender | Female
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Dates
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Enumeration Date | 01/02/2025
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Last Update Date | 01/02/2025
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Provider Practice Location Address
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Address Line | 86 COOPER LAKE RD SE
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City | MABLETON
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State | GA
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Zip | 30126-1802
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Country | US
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Telephone | 770-284-0501
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Fax |
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Provider Business Mailing Address
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Address Line | 5284 FLOYD RD SW UNIT 1929
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City | MABLETON
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State | GA
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Zip | 30126-6118
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Country | US
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Telephone | 812-987-1507
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | MSW011245
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License Number State | GA
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