Provider Demographics
NPI:1518269208
Name:CASTLEBERRY, MICHELLE LYNN (LCSW)
Entity Type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:LYNN
Last Name:CASTLEBERRY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2650 FLAT ROCK RD
Mailing Address - Street 2:
Mailing Address - City:WATKINSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30677-3122
Mailing Address - Country:US
Mailing Address - Phone:706-619-1909
Mailing Address - Fax:
Practice Address - Street 1:1435 OGLETHORPE AVE
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30606-2135
Practice Address - Country:US
Practice Address - Phone:706-549-7755
Practice Address - Fax:706-549-0428
Is Sole Proprietor?:No
Enumeration Date:2010-12-01
Last Update Date:2020-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALCSW0043601041C0700X
GACSW0043601041C0700X
GALSCW0043601041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical