Provider Demographics
NPI:1023831492
Name:DACK, LAUREN MCCUTCHEN (LPC, LMFT)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:MCCUTCHEN
Last Name:DACK
Suffix:
Gender:F
Credentials:LPC, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:275 SEALE LN
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30022-6137
Mailing Address - Country:US
Mailing Address - Phone:770-695-6811
Mailing Address - Fax:
Practice Address - Street 1:5755 N POINT PKWY STE 248
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30022-1173
Practice Address - Country:US
Practice Address - Phone:404-913-1102
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-05
Last Update Date:2024-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMFT1280101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional