Basic Information
| Provider Information | |||||||||
| NPI: | 1518269208 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CASTLEBERRY | ||||||||
| FirstName: | MICHELLE | ||||||||
| MiddleName: | LYNN | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2650 FLAT ROCK RD | ||||||||
| Address2: | |||||||||
| City: | WATKINSVILLE | ||||||||
| State: | GA | ||||||||
| PostalCode: | 306773122 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7066191909 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1435 OGLETHORPE AVE | ||||||||
| Address2: | |||||||||
| City: | ATHENS | ||||||||
| State: | GA | ||||||||
| PostalCode: | 306062135 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7065497755 | ||||||||
| FaxNumber: | 7065490428 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/01/2010 | ||||||||
| LastUpdateDate: | 12/03/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/03/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | LCSW004360 | GA | N | Behavioral Health & Social Service Providers | Social Worker | Clinical | 1041C0700X | CSW004360 | GA | N | Behavioral Health & Social Service Providers | Social Worker | Clinical | 1041C0700X | LSCW004360 | GA | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.