Individual
DERRICK CHRISTOPHER LAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
4229 SNAPFINGER WOODS DR, DECATUR, GA 30035-3440
(404) 286-9252
(404) 286-9253
Mailing address
4229 SNAPFINGER WOODS DR, DECATUR, GA 30035-3440
(404) 286-9252
(404) 286-9253
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
CSW1003152
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CSW003152
STATE LICENSE
GA
Enumeration date
04/25/2008
Last updated
03/17/2018
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