Provider Demographics
NPI:1912662495
Name:DUBNIK, TANDI (CADC-II, ICADC)
Entity Type:Individual
Prefix:
First Name:TANDI
Middle Name:
Last Name:DUBNIK
Suffix:
Gender:F
Credentials:CADC-II, ICADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1575 WYNTERCREEK CT
Mailing Address - Street 2:
Mailing Address - City:HOSCHTON
Mailing Address - State:GA
Mailing Address - Zip Code:30548-3660
Mailing Address - Country:US
Mailing Address - Phone:678-371-1113
Mailing Address - Fax:
Practice Address - Street 1:1575 WYNTERCREEK CT
Practice Address - Street 2:
Practice Address - City:HOSCHTON
Practice Address - State:GA
Practice Address - Zip Code:30548-3660
Practice Address - Country:US
Practice Address - Phone:678-371-1113
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-01
Last Update Date:2021-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1202101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)