Provider Demographics
NPI:1801144373
Name:DETTMAN, EMILY RACHEL (MA,LPC, NCC)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:RACHEL
Last Name:DETTMAN
Suffix:
Gender:F
Credentials:MA,LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 PEACHTREE PKWY
Mailing Address - Street 2:SUITE 112
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30041-7461
Mailing Address - Country:US
Mailing Address - Phone:847-337-5747
Mailing Address - Fax:
Practice Address - Street 1:600 PEACHTREE PKWY
Practice Address - Street 2:SUITE 112
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30041-7461
Practice Address - Country:US
Practice Address - Phone:847-337-5747
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-15
Last Update Date:2016-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC007840101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional