Provider Demographics
NPI:1174685234
Name:ROUTLY, DAVID G (MA CPCS MATS)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:G
Last Name:ROUTLY
Suffix:
Gender:M
Credentials:MA CPCS MATS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4171 AMBERFIELD CIR
Mailing Address - Street 2:
Mailing Address - City:NORCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:30092-5115
Mailing Address - Country:US
Mailing Address - Phone:678-360-9639
Mailing Address - Fax:
Practice Address - Street 1:4171 AMBERFIELD CIR
Practice Address - Street 2:
Practice Address - City:NORCROSS
Practice Address - State:GA
Practice Address - Zip Code:30092-5115
Practice Address - Country:US
Practice Address - Phone:678-360-9639
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-15
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAPC001386101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor