Provider Demographics
NPI:1801305354
Name:THE DECISION TREE, LLC
Entity type:Organization
Organization Name:THE DECISION TREE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:MONTAGUE
Authorized Official - Last Name:KINLAW
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW, MAC
Authorized Official - Phone:912-520-8084
Mailing Address - Street 1:2525 MOODY RD STE 121
Mailing Address - Street 2:
Mailing Address - City:WARNER ROBINS
Mailing Address - State:GA
Mailing Address - Zip Code:31088-6110
Mailing Address - Country:US
Mailing Address - Phone:478-225-2044
Mailing Address - Fax:478-225-2043
Practice Address - Street 1:2525 MOODY RD STE 121
Practice Address - Street 2:
Practice Address - City:WARNER ROBINS
Practice Address - State:GA
Practice Address - Zip Code:31088-6110
Practice Address - Country:US
Practice Address - Phone:478-225-2044
Practice Address - Fax:478-225-2043
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE DECISION TREE, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-09-28
Last Update Date:2023-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041C0700X
GACSW004819261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty