Provider Demographics
NPI:1689910333
Name:DURHAM, KATIE (LPC)
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:
Last Name:DURHAM
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 1:6003 VETERANS PKWY STE 100
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31909-6284
Mailing Address - Country:US
Mailing Address - Phone:706-223-1933
Mailing Address - Fax:
Practice Address - Street 1:5700 VETERANS PKWY
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31904-9093
Practice Address - Country:US
Practice Address - Phone:706-221-3222
Practice Address - Fax:706-223-1934
Is Sole Proprietor?:No
Enumeration Date:2012-12-28
Last Update Date:2023-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003200761AMedicaid