Provider Demographics
NPI:1649780156
Name:BARON, COURTNEY J (LPC)
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:J
Last Name:BARON
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 1:698 N MARIETTA PKWY NE STE A
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30060-1586
Mailing Address - Country:US
Mailing Address - Phone:770-919-9088
Mailing Address - Fax:770-919-8708
Practice Address - Street 1:698 N MARIETTA PKWY NE STE A
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060-1586
Practice Address - Country:US
Practice Address - Phone:770-919-9088
Practice Address - Fax:770-919-8708
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-10
Last Update Date:2017-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC009685101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty