Provider Demographics
NPI:1033256623
Name:BRENT, ANDREW J (LPC)
Entity Type:Individual
Prefix:MR
First Name:ANDREW
Middle Name:J
Last Name:BRENT
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:368 HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:CORNELIA
Mailing Address - State:GA
Mailing Address - Zip Code:30531-4365
Mailing Address - Country:US
Mailing Address - Phone:706-939-1035
Mailing Address - Fax:706-776-3235
Practice Address - Street 1:358 HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:CORNELIA
Practice Address - State:GA
Practice Address - Zip Code:30531
Practice Address - Country:US
Practice Address - Phone:706-939-1035
Practice Address - Fax:706-776-3235
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA3457101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor