Provider Demographics
NPI:1619225315
Name:CARTER, KOURTNEY DENISE (LMSW)
Entity Type:Individual
Prefix:
First Name:KOURTNEY
Middle Name:DENISE
Last Name:CARTER
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5950 LIVE OAK PKWY
Mailing Address - Street 2:STE 204
Mailing Address - City:NORCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:30093-1743
Mailing Address - Country:US
Mailing Address - Phone:770-892-7637
Mailing Address - Fax:
Practice Address - Street 1:1000 JOHNSON FERRY ROAD N.E.
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-1611
Practice Address - Country:US
Practice Address - Phone:404-300-2144
Practice Address - Fax:404-851-8271
Is Sole Proprietor?:No
Enumeration Date:2012-08-28
Last Update Date:2021-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMSW0056891041S0200X
GALCSW55621041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool