Provider Demographics
NPI:1063017564
Name:GREGOIRE, BRANDY DONOVAN (LPC, NCC)
Entity Type:Individual
Prefix:
First Name:BRANDY
Middle Name:DONOVAN
Last Name:GREGOIRE
Suffix:
Gender:F
Credentials:LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:561 BLUE HERON LN
Mailing Address - Street 2:
Mailing Address - City:MADISONVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70447-3251
Mailing Address - Country:US
Mailing Address - Phone:504-301-6525
Mailing Address - Fax:
Practice Address - Street 1:3005 HARVARD AVE STE 201
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70006-6401
Practice Address - Country:US
Practice Address - Phone:504-301-6525
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-02
Last Update Date:2020-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA6086101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor