Derrick Christopher Lake, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

CSW1003152 Issued in GA

Practice address

4229 Snapfinger Woods Dr
Decatur, GA 30035-3440

Phone

(404) 286-9252

Fax

(404) 286-9253

NPI assigned

Apr 25, 2008

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in GA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://fhir4.healow.com/fhir/r4/DEGGAD

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Renaissance Counseling Services,LLC

  • Community/Behavioral Health Agency
  • Decatur, GA
  • NPI 1912106568
  Medicare reassignment NPD
• Recovery Consultants of Atlanta, Inc.

  • Federally Qualified Health Center (FQHC)
  • Decatur, GA
  • NPI 1053769273
  NPD (past)
• Recovery Consultants of Atlanta, Inc.

  • Federally Qualified Health Center (FQHC)
  • Tucker, GA
  • NPI 1851482376
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1209081600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1521244800000",
    "number": "1982879490",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4229 SNAPFINGER WOODS DR",
            "city": "DECATUR",
            "state": "GA",
            "postal_code": "300353440",
            "telephone_number": "404-286-9252",
            "fax_number": "404-286-9253"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4229 SNAPFINGER WOODS DR",
            "city": "DECATUR",
            "state": "GA",
            "postal_code": "300353440",
            "telephone_number": "404-286-9252",
            "fax_number": "404-286-9253"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1050 Crown Pointe Pkwy",
            "address_2": "Ste. 295",
            "address_purpose": "LOCATION",
            "city": "Atlanta",
            "state": "GA",
            "postal_code": "303387707",
            "country_code": "US",
            "telephone_number": "866-325-5434",
            "fax_number": "866-325-5340",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LAKE",
        "first_name": "DERRICK",
        "middle_name": "CHRISTOPHER",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-04-25",
        "last_updated": "2018-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "GA",
            "license": "CSW1003152",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "CSW003152",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Lag Youth Foundation Inc
• Elizabeth Lahaie, MSN, BSN, RN
• Jayce Laing-Green, LMSW
• Susan K Laird, DNP, MSN, RN
• Susan Margaret Laird, PH.D.
• Kanwal Kapadia Lalani, PA
• Alicia N Lalla, PT, DPT
• Karrion D Lalor, LPC
• Elouise Lamar
• Exie Latrice Lamar

• Clinical Social Worker in Decatur, GA
• Providers in Decatur, GA by specialty
• Clinical Social Worker in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.