Provider Demographics
NPI:1033462270
Name:PAYNE, TAMARA BROWN (PHD, CRC, LPC, NCC)
Entity Type:Individual
Prefix:DR
First Name:TAMARA
Middle Name:BROWN
Last Name:PAYNE
Suffix:
Gender:F
Credentials:PHD, CRC, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3593 QUILLBACK CT
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30349-1893
Mailing Address - Country:US
Mailing Address - Phone:678-773-3058
Mailing Address - Fax:866-742-4145
Practice Address - Street 1:1882 PRINCETON AVE
Practice Address - Street 2:SUITE 9
Practice Address - City:COLLEGE PARK
Practice Address - State:GA
Practice Address - Zip Code:30337-3537
Practice Address - Country:US
Practice Address - Phone:678-773-3058
Practice Address - Fax:866-742-4145
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-25
Last Update Date:2012-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC003973101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional