Provider Demographics
NPI:1528297991
Name:LILLARD, DEBRA L (LCSW)
Entity type:Individual
Prefix:MS
First Name:DEBRA
Middle Name:L
Last Name:LILLARD
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:PO BOX 322
Mailing Address - Street 2:
Mailing Address - City:PINE LAKE
Mailing Address - State:GA
Mailing Address - Zip Code:30072-0322
Mailing Address - Country:US
Mailing Address - Phone:404-286-1177
Mailing Address - Fax:
Practice Address - Street 1:635 OLIVE RD.
Practice Address - Street 2:
Practice Address - City:PINE LAKE
Practice Address - State:GA
Practice Address - Zip Code:30072
Practice Address - Country:US
Practice Address - Phone:404-286-1177
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-07
Last Update Date:2009-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0019281041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical