Provider Demographics
NPI:1093741852
Name:WELBORN, DEBORAH B (LCSW)
Entity Type:Individual
Prefix:MS
First Name:DEBORAH
Middle Name:B
Last Name:WELBORN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:DEBORAH
Other - Middle Name:W
Other - Last Name:REINIGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:454 MISSOURI ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94107
Mailing Address - Country:US
Mailing Address - Phone:803-599-2067
Mailing Address - Fax:
Practice Address - Street 1:1205 TROUP ST
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30904
Practice Address - Country:US
Practice Address - Phone:803-599-2067
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-23
Last Update Date:2007-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0009831041C0700X
GA000983GA104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA888PBXMedicaid
GA78728585OtherUNITED HEALTH CARE
GAA313596OtherVALUE OPTIONS
GA4122024Medicare ID - Type Unspecified