Active NPI
Channelle Lavonne Refuge, LMSW
- Social Worker
- Mableton, GA
National Provider Identifier
1508675745
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Social Worker
- License
- MSW011245
- Practice address
- 86 Cooper Lake Rd SE
Mableton, GA 30126-1802 - Phone
- (770) 284-0501
- NPI assigned
- Jan 2, 2025
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Social Worker | 104100000X | MSW011245 | GA | Primary |
Addresses
Primary practice location
86 Cooper Lake Rd SE
Mableton, GA 30126-1802
Mailing address
5284 Floyd Rd SW Unit 1929
Mableton, GA 30126-6118
Phone (812) 987-1507
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MSW011245 | GA | MD | Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1735776000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1735776000000",
"number": "1508675745",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5284 FLOYD RD SW UNIT 1929",
"city": "MABLETON",
"state": "GA",
"postal_code": "301266118",
"telephone_number": "812-987-1507"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "86 COOPER LAKE RD SE",
"city": "MABLETON",
"state": "GA",
"postal_code": "301261802",
"telephone_number": "770-284-0501"
}
],
"practiceLocations": [],
"basic": {
"last_name": "REFUGE",
"first_name": "CHANNELLE",
"middle_name": "LAVONNE",
"credential": "LMSW",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2025-01-02",
"last_updated": "2025-01-02",
"certification_date": "2025-01-02",
"status": "A"
},
"taxonomies": [
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "GA",
"license": "MSW011245",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Mableton, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 2, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.