Provider Demographics
NPI:1710335385
Name:DURHAM, CATELYN DAKE (MS, LPC)
Entity Type:Individual
Prefix:MRS
First Name:CATELYN
Middle Name:DAKE
Last Name:DURHAM
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 374
Mailing Address - Street 2:
Mailing Address - City:BRASELTON
Mailing Address - State:GA
Mailing Address - Zip Code:30517-0007
Mailing Address - Country:US
Mailing Address - Phone:413-776-4357
Mailing Address - Fax:
Practice Address - Street 1:3966 S BOGAN RD
Practice Address - Street 2:
Practice Address - City:BUFORD
Practice Address - State:GA
Practice Address - Zip Code:30519-8633
Practice Address - Country:US
Practice Address - Phone:678-765-8276
Practice Address - Fax:678-765-8274
Is Sole Proprietor?:No
Enumeration Date:2016-05-24
Last Update Date:2021-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAPC005155101YP2500X
GALPC009740101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional