Healthcare Provider Details

I. General information

NPI: 1013217124
Provider Name (Legal Business Name): COURTNEY LYNN ROSE JAMES MS, GA, NY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: COURTNEY LYNN ROSE NEWSOME MS

II. Dates (important events)

Enumeration Date: 10/25/2010
Last Update Date: 07/31/2026
Certification Date: 07/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 VALLEY RD
COVINGTON GA
30016-7299
US

IV. Provider business mailing address

315 VALLEY RD
COVINGTON GA
30016-7299
US

V. Phone/Fax

Practice location:
  • Phone: 601-297-7387
  • Fax: 678-605-9980
Mailing address:
  • Phone: 601-297-7387
  • Fax: 678-605-9980

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-20-141298
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-23-65049
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: