Provider Demographics
NPI:1083485940
Name:WISEMAN, BRIANNA (LPC)
Entity Type:Individual
Prefix:
First Name:BRIANNA
Middle Name:
Last Name:WISEMAN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:409 OLD BORING LN
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:GA
Mailing Address - Zip Code:30189-2495
Mailing Address - Country:US
Mailing Address - Phone:770-928-7300
Mailing Address - Fax:
Practice Address - Street 1:409 OLD BORING LN
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:GA
Practice Address - Zip Code:30189-2495
Practice Address - Country:US
Practice Address - Phone:770-928-7300
Practice Address - Fax:770-928-7558
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-10
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional