Provider Demographics
NPI:1699979625
Name:COURTNEY, KATHLEEN EMILIE (LCSW)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:EMILIE
Last Name:COURTNEY
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 1:1231 WOODLAND AVE NE
Mailing Address - Street 2:UNIT 2
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30324-4538
Mailing Address - Country:US
Mailing Address - Phone:404-853-2800
Mailing Address - Fax:404-685-0204
Practice Address - Street 1:1105 WEST PEACHTREE ST., NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30357-0948
Practice Address - Country:US
Practice Address - Phone:404-853-2800
Practice Address - Fax:404-685-0204
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0004711041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical