Provider Demographics
NPI:1750041299
Name:DEROECK, ALLISON (LCSW)
Entity type:Individual
Prefix:
First Name:ALLISON
Middle Name:
Last Name:DEROECK
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 1:1551 JENNINGS MILL RD UNIT 1700B
Mailing Address - Street 2:
Mailing Address - City:WATKINSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30677-7266
Mailing Address - Country:US
Mailing Address - Phone:229-560-2310
Mailing Address - Fax:
Practice Address - Street 1:1551 JENNINGS MILL RD UNIT 1700B
Practice Address - Street 2:
Practice Address - City:WATKINSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30677-7266
Practice Address - Country:US
Practice Address - Phone:229-560-2310
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-25
Last Update Date:2025-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW008347104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker