Provider Demographics
NPI:1457992075
Name:MANN, COURTNEY (LPC)
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:
Last Name:MANN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1301 SHILOH RD NW STE 811
Mailing Address - Street 2:
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30144-7156
Mailing Address - Country:US
Mailing Address - Phone:678-389-1194
Mailing Address - Fax:
Practice Address - Street 1:1301 SHILOH RD NW STE 811
Practice Address - Street 2:
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30144-7156
Practice Address - Country:US
Practice Address - Phone:678-389-1194
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-04
Last Update Date:2019-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC008483101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health