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General NPI Number Information
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NPI Number | 1225751597
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Entity Type | Individual
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Provider Name | COURTNEY MUZAC
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Gender | Female
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Dates
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Enumeration Date | 09/22/2022
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Last Update Date | 09/22/2022
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Provider Practice Location Address
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Address Line | 1585 OLD NORCROSS RD STE 204B
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City | LAWRENCEVILLE
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State | GA
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Zip | 30046-4043
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Country | US
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Telephone | 610-762-6563
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Fax |
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Provider Business Mailing Address
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Address Line | 2730 PEACHTREE INDUSTRIAL BLVD STE 105
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City | DULUTH
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State | GA
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Zip | 30097-8627
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Country | US
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Telephone | 610-762-6563
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | MSW010529
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License Number State | GA
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