Provider Demographics
NPI:1124601240
Name:DEAN, TONI ELIZABETH HAGIN (LMSW)
Entity Type:Individual
Prefix:MRS
First Name:TONI
Middle Name:ELIZABETH HAGIN
Last Name:DEAN
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:TONI
Other - Middle Name:ELIZABETH
Other - Last Name:HAGIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW
Mailing Address - Street 1:3702 WINCHESTER WAY
Mailing Address - Street 2:
Mailing Address - City:MARTINEZ
Mailing Address - State:GA
Mailing Address - Zip Code:30907-3398
Mailing Address - Country:US
Mailing Address - Phone:912-222-0434
Mailing Address - Fax:
Practice Address - Street 1:1 FREEDOM WAY
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30904-6258
Practice Address - Country:US
Practice Address - Phone:706-733-0188
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-05
Last Update Date:2021-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMSW008434104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker