Basic Information
| Provider Information | |||||||||
| NPI: | 1225342058 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KINLAW | ||||||||
| FirstName: | DEBORAH | ||||||||
| MiddleName: | MONTAGUE | ||||||||
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| Credential: | LCSW, MAC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1114 HWY 96 | ||||||||
| Address2: | SUITE C-1, BOX 309 | ||||||||
| City: | KATHLEEN | ||||||||
| State: | GA | ||||||||
| PostalCode: | 31088 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9125208084 | ||||||||
| FaxNumber: | 4783133013 | ||||||||
| Practice Location | |||||||||
| Address1: | 402 CORDER RD STE 200 | ||||||||
| Address2: | |||||||||
| City: | WARNER ROBINS | ||||||||
| State: | GA | ||||||||
| PostalCode: | 310887165 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4785514714 | ||||||||
| FaxNumber: | 4785514718 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/04/2010 | ||||||||
| LastUpdateDate: | 05/28/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/28/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | MSW004964 | GA | N | Behavioral Health & Social Service Providers | Social Worker | Clinical | 1041C0700X | CSW004819 | GA | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.