Provider Demographics
NPI:1003055104
Name:FAISON-BRADLEY, LASHAWN (LPC, PSYD)
Entity Type:Individual
Prefix:DR
First Name:LASHAWN
Middle Name:
Last Name:FAISON-BRADLEY
Suffix:
Gender:F
Credentials:LPC, PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8332 OFFICE PARK DR
Mailing Address - Street 2:SUITE H
Mailing Address - City:DOUGLASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30134-6937
Mailing Address - Country:US
Mailing Address - Phone:404-907-6635
Mailing Address - Fax:
Practice Address - Street 1:44 DARBYS CROSSING DR STE 202
Practice Address - Street 2:
Practice Address - City:HIRAM
Practice Address - State:GA
Practice Address - Zip Code:30141-6008
Practice Address - Country:US
Practice Address - Phone:404-907-6635
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-12
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GANONE103TC0700X
GALPC003392101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003187089AMedicaid
GA003159462AMedicaid