Provider Demographics
NPI:1467044362
Name:KOEPNICK, DAVID (MA, LAPC, CAMS-II)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:KOEPNICK
Suffix:
Gender:M
Credentials:MA, LAPC, CAMS-II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:158 OAK MEADOW DR
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30605-4550
Mailing Address - Country:US
Mailing Address - Phone:706-765-7512
Mailing Address - Fax:
Practice Address - Street 1:644 N CHASE ST # 104
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30601-1960
Practice Address - Country:US
Practice Address - Phone:706-898-3276
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-11
Last Update Date:2024-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC014879101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional