Provider Demographics
NPI:1740503903
Name:DOBBINS, OMI J (LPC, NCC)
Entity type:Individual
Prefix:DR
First Name:OMI
Middle Name:J
Last Name:DOBBINS
Suffix:
Gender:F
Credentials:LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:159 BURKE ST
Mailing Address - Street 2:SUITE 202
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-3430
Mailing Address - Country:US
Mailing Address - Phone:678-960-9355
Mailing Address - Fax:888-778-1614
Practice Address - Street 1:159 BURKE ST
Practice Address - Street 2:SUITE 202
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-3430
Practice Address - Country:US
Practice Address - Phone:678-960-9355
Practice Address - Fax:888-778-1614
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-02
Last Update Date:2014-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC004958101Y00000X, 101YP2500X
GA681838101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003101354AMedicaid