Provider Demographics
NPI:1619651494
Name:STUBBS, COURTNEY LEE (LCSW)
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:LEE
Last Name:STUBBS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:507 EDGE RD
Mailing Address - Street 2:
Mailing Address - City:FORSYTH
Mailing Address - State:GA
Mailing Address - Zip Code:31029-6307
Mailing Address - Country:US
Mailing Address - Phone:478-808-5129
Mailing Address - Fax:
Practice Address - Street 1:507 EDGE RD
Practice Address - Street 2:
Practice Address - City:FORSYTH
Practice Address - State:GA
Practice Address - Zip Code:31029-6307
Practice Address - Country:US
Practice Address - Phone:478-808-5129
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-13
Last Update Date:2023-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0064921041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical