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General NPI Number Information
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NPI Number | 1801035670
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Entity Type | Individual
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Provider Name | DEBRA A DANTZLER PH.D., LPC
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Gender | Female
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Dates
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Enumeration Date | 02/18/2009
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Last Update Date | 06/02/2011
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Provider Practice Location Address
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Address Line | 131 PONCE DE LEON AVE NE SUITE 233
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City | ATLANTA
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State | GA
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Zip | 30308-1962
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Country | US
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Telephone | 404-272-2770
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Fax | 404-272-2770
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Provider Business Mailing Address
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Address Line | 618 S RAYS RD
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City | STONE MOUNTAIN
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State | GA
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Zip | 30083-4605
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Country | US
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Telephone | 404-272-2770
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 05479
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License Number State | GA
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