Provider Demographics
NPI:1851469076
Name:JURKOVIC, LORI KATHERINE (MA, LMFT)
Entity type:Individual
Prefix:MRS
First Name:LORI
Middle Name:KATHERINE
Last Name:JURKOVIC
Suffix:
Gender:F
Credentials:MA, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1506 WILLOW BND
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:GA
Mailing Address - Zip Code:30188-4640
Mailing Address - Country:US
Mailing Address - Phone:404-401-4478
Mailing Address - Fax:
Practice Address - Street 1:1513 JOHNSON FERRY RD
Practice Address - Street 2:SUITE T-1
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30062-8101
Practice Address - Country:US
Practice Address - Phone:770-578-1744
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0627106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist