Provider Demographics
NPI:1730722521
Name:CHILDRESS, DEBBIE JEAN (MA, CADC II)
Entity type:Individual
Prefix:MS
First Name:DEBBIE
Middle Name:JEAN
Last Name:CHILDRESS
Suffix:
Gender:F
Credentials:MA, CADC II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6132 HAWKINSVILLE RD
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31216-5848
Mailing Address - Country:US
Mailing Address - Phone:478-788-0066
Mailing Address - Fax:
Practice Address - Street 1:6132 HAWKINSVILLE RD
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31216-5848
Practice Address - Country:US
Practice Address - Phone:478-788-0066
Practice Address - Fax:478-788-3104
Is Sole Proprietor?:No
Enumeration Date:2019-10-24
Last Update Date:2021-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1286101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)