Provider Demographics
NPI:1801035670
Name:DANTZLER, DEBRA A (PHD, LPC)
Entity Type:Individual
Prefix:DR
First Name:DEBRA
Middle Name:A
Last Name:DANTZLER
Suffix:
Gender:F
Credentials:PHD, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:618 S RAYS RD
Mailing Address - Street 2:
Mailing Address - City:STONE MOUNTAIN
Mailing Address - State:GA
Mailing Address - Zip Code:30083-4605
Mailing Address - Country:US
Mailing Address - Phone:404-272-2770
Mailing Address - Fax:
Practice Address - Street 1:131 PONCE DE LEON AVE NE
Practice Address - Street 2:SUITE 233
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30308-1962
Practice Address - Country:US
Practice Address - Phone:404-272-2770
Practice Address - Fax:404-272-2770
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-18
Last Update Date:2011-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA05479101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional