Provider Demographics
NPI:1942552211
Name:BARNES, DEMORISE (LMSW)
Entity Type:Individual
Prefix:
First Name:DEMORISE
Middle Name:
Last Name:BARNES
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:PO BOX 1491
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30903-1491
Mailing Address - Country:US
Mailing Address - Phone:601-808-1820
Mailing Address - Fax:
Practice Address - Street 1:135 BOUNDS ST STE 107
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39206-4121
Practice Address - Country:US
Practice Address - Phone:601-808-1820
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-10
Last Update Date:2021-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0062471041C0700X
MSC95281041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000606317BMedicaid
GA000606317BMedicaid