Provider Demographics
NPI:1962631135
Name:KURTZ, MARJORIE EDWARDS (MA)
Entity Type:Individual
Prefix:MRS
First Name:MARJORIE
Middle Name:EDWARDS
Last Name:KURTZ
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:365 HILLGROVE DR
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:GA
Mailing Address - Zip Code:30114-8602
Mailing Address - Country:US
Mailing Address - Phone:404-769-2641
Mailing Address - Fax:
Practice Address - Street 1:365 HILLGROVE DR
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:GA
Practice Address - Zip Code:30114-8602
Practice Address - Country:US
Practice Address - Phone:404-769-2641
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-09
Last Update Date:2018-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH10441101YM0800X
GALPC006901101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health