Individual
DEBORAH A LAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
248 E CAPITOL ST, 840 TRUST MARK BLDG, JACKSON, MS 39201-2503
(800) 632-6074
(866) 341-7509
Mailing address
PO BOX 10414, LARGO, FL 33773-0414
(800) 632-6074
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
C0798
MS
Other
Enumeration date
10/16/2006
Last updated
07/08/2007
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