Provider Demographics
NPI:1043468747
Name:DALTON, CHRISTINE B (LCSW)
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:B
Last Name:DALTON
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 1:83 ATHENS ST
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON
Mailing Address - State:GA
Mailing Address - Zip Code:30549-1401
Mailing Address - Country:US
Mailing Address - Phone:706-387-0573
Mailing Address - Fax:706-387-0573
Practice Address - Street 1:83 ATHENS ST
Practice Address - Street 2:
Practice Address - City:JEFFERSON
Practice Address - State:GA
Practice Address - Zip Code:30549-1401
Practice Address - Country:US
Practice Address - Phone:706-387-0573
Practice Address - Fax:706-387-0573
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-05
Last Update Date:2014-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA40241041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA817420986AMedicaid
GA817420986AMedicaid