Provider Demographics
NPI:1023483070
Name:DOMBROWSKI, COURTNEY (MA, LPCA)
Entity type:Individual
Prefix:
First Name:COURTNEY
Middle Name:
Last Name:DOMBROWSKI
Suffix:
Gender:F
Credentials:MA, LPCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1637 ATHENS HWY
Mailing Address - Street 2:
Mailing Address - City:GRAYSON
Mailing Address - State:GA
Mailing Address - Zip Code:30017-1768
Mailing Address - Country:US
Mailing Address - Phone:678-508-5682
Mailing Address - Fax:
Practice Address - Street 1:1637 ATHENS HWY
Practice Address - Street 2:
Practice Address - City:GRAYSON
Practice Address - State:GA
Practice Address - Zip Code:30017-1768
Practice Address - Country:US
Practice Address - Phone:678-508-5682
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-02
Last Update Date:2015-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAPC004444101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor