Provider Demographics
NPI:1437188992
Name:LILLIBRIDGE, DEBORAH KAY (LMSW)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:KAY
Last Name:LILLIBRIDGE
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2497 JACKSON RD
Mailing Address - Street 2:
Mailing Address - City:GRIFFIN
Mailing Address - State:GA
Mailing Address - Zip Code:30223-8463
Mailing Address - Country:US
Mailing Address - Phone:678-313-5248
Mailing Address - Fax:
Practice Address - Street 1:750 RIVERSIDE DR
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31201-2611
Practice Address - Country:US
Practice Address - Phone:478-477-3813
Practice Address - Fax:478-746-7023
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2010-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMSW003107104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker