Provider Demographics
NPI:1225342058
Name:KINLAW, DEBORAH MONTAGUE (LCSW, MAC)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:MONTAGUE
Last Name:KINLAW
Suffix:
Gender:F
Credentials:LCSW, MAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1114 HWY 96
Mailing Address - Street 2:SUITE C-1, BOX 309
Mailing Address - City:KATHLEEN
Mailing Address - State:GA
Mailing Address - Zip Code:31088
Mailing Address - Country:US
Mailing Address - Phone:912-520-8084
Mailing Address - Fax:478-313-3013
Practice Address - Street 1:402 CORDER RD STE 200
Practice Address - Street 2:
Practice Address - City:WARNER ROBINS
Practice Address - State:GA
Practice Address - Zip Code:31088-7165
Practice Address - Country:US
Practice Address - Phone:478-551-4714
Practice Address - Fax:478-551-4718
Is Sole Proprietor?:No
Enumeration Date:2010-08-04
Last Update Date:2021-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMSW0049641041C0700X
GACSW0048191041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical