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General NPI Number Information
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NPI Number | 1063604403
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Entity Type | Individual
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Provider Name | JOHN DURY LPC, MFT, MAC, SAP
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Gender | Male
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Dates
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Enumeration Date | 08/09/2007
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Last Update Date | 05/16/2008
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Provider Practice Location Address
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Address Line | 1180 OLD TUCKER RD
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City | STONE MOUNTAIN
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State | GA
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Zip | 30087-3030
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Country | US
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Telephone | 770-921-2800
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Fax |
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Provider Business Mailing Address
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Address Line | 1180 OLD TUCKER RD
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City | STONE MOUNTAIN
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State | GA
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Zip | 30087-3030
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Country | US
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Telephone | 770-921-2800
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 38618
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 002917
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License Number State | GA
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