Provider Demographics
NPI:1164824363
Name:MCCURDY, PATTI (LMFT)
Entity Type:Individual
Prefix:
First Name:PATTI
Middle Name:
Last Name:MCCURDY
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:MS
Other - First Name:PATTI
Other - Middle Name:
Other - Last Name:MCCURDY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMFT
Mailing Address - Street 1:109 CONSTITUTION DR STE 100
Mailing Address - Street 2:
Mailing Address - City:WARNER ROBINS
Mailing Address - State:GA
Mailing Address - Zip Code:31088-8046
Mailing Address - Country:US
Mailing Address - Phone:478-396-8388
Mailing Address - Fax:478-333-1502
Practice Address - Street 1:109 CONSTITUTION DR STE 100
Practice Address - Street 2:
Practice Address - City:WARNER ROBINS
Practice Address - State:GA
Practice Address - Zip Code:31088-8046
Practice Address - Country:US
Practice Address - Phone:478-396-8388
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-18
Last Update Date:2019-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMFT001494106H00000X
GAMFT1001494106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003182335AMedicaid