Provider Demographics
NPI:1912313826
Name:DURBIN, CHARYL (LPC)
Entity type:Individual
Prefix:DR
First Name:CHARYL
Middle Name:
Last Name:DURBIN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4247 SKYLINE VW
Mailing Address - Street 2:
Mailing Address - City:OAKWOOD
Mailing Address - State:GA
Mailing Address - Zip Code:30566-4307
Mailing Address - Country:US
Mailing Address - Phone:678-387-9076
Mailing Address - Fax:678-807-2834
Practice Address - Street 1:4247 SKYLINE VW
Practice Address - Street 2:
Practice Address - City:OAKWOOD
Practice Address - State:GA
Practice Address - Zip Code:30566-4307
Practice Address - Country:US
Practice Address - Phone:678-387-9076
Practice Address - Fax:678-807-2834
Is Sole Proprietor?:No
Enumeration Date:2014-07-11
Last Update Date:2020-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC003678101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional