Healthcare Provider Details

I. General information

NPI: 1518414101
Provider Name (Legal Business Name): DAVID ALAN STURGESS JR. LPC, NCC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2016
Last Update Date: 09/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

696 COURTENAY DR, NE
ATLANTA GA
30306
US

IV. Provider business mailing address

696 COURTENAY DR, NE
ATLANTA GA
30306
US

V. Phone/Fax

Practice location:
  • Phone: 404-875-4551
  • Fax: 404-875-1394
Mailing address:
  • Phone: 404-875-4551
  • Fax: 404-875-1394

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPC007275
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: