Provider Demographics
NPI:1063604403
Name:DURY, JOHN (LPC, MFT, MAC, SAP)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:DURY
Suffix:
Gender:M
Credentials:LPC, MFT, MAC, SAP
Other - Prefix:
Other - First Name:JOHN
Other - Middle Name:
Other - Last Name:SWANGO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC, LMFT, MAC, SAP
Mailing Address - Street 1:1180 OLD TUCKER RD
Mailing Address - Street 2:
Mailing Address - City:STONE MOUNTAIN
Mailing Address - State:GA
Mailing Address - Zip Code:30087-3030
Mailing Address - Country:US
Mailing Address - Phone:770-921-2800
Mailing Address - Fax:
Practice Address - Street 1:1180 OLD TUCKER RD
Practice Address - Street 2:
Practice Address - City:STONE MOUNTAIN
Practice Address - State:GA
Practice Address - Zip Code:30087-3030
Practice Address - Country:US
Practice Address - Phone:770-921-2800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-09
Last Update Date:2008-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA38618106H00000X
GA002917101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist