Lake, Derrick Christopher

Lake, Derrick Christopher is an individual health care provider with primary practice located at 4229 Snapfinger Woods Dr , Decatur GA 30035-3440. He recently has only one registered license in Behavioral Health & Social Service Providers / Clinical, which is considered as his primary health care specialty. Lake, Derrick Christopher can be contacted via phone (404) 286-9252.

Contact Information

Primary practice address
4229 Snapfinger Woods Dr Decatur GA 30035-3440
Phone: (404) 286-9252
Fax: (404) 286-9253
Website:
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Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Clinical 1041C0700X CSW1003152 Georgia

Profile Details

NPI number 1982879490
LBN Legal business name Lake, Derrick Christopher
Credentials Licensed Clinical Social Worker (LCSW)
Entity Individual
Sole proprietor 1 No
Enumeration date Apr 25th, 2008
Last updated Mar 17th, 2018 - about 6 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1982879490 NPPES
Georgia Other CSW003152 STATE LICENSE

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