Provider Demographics
NPI:1114501806
Name:BRINKMEYER, LESLIE (LMSW)
Entity Type:Individual
Prefix:MS
First Name:LESLIE
Middle Name:
Last Name:BRINKMEYER
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2801 BUFORD HWY NE STE T60
Mailing Address - Street 2:
Mailing Address - City:BROOKHAVEN
Mailing Address - State:GA
Mailing Address - Zip Code:30329-2145
Mailing Address - Country:US
Mailing Address - Phone:678-701-7246
Mailing Address - Fax:
Practice Address - Street 1:2801 BUFORD HWY NE STE T60
Practice Address - Street 2:
Practice Address - City:BROOKHAVEN
Practice Address - State:GA
Practice Address - Zip Code:30329-2145
Practice Address - Country:US
Practice Address - Phone:678-701-7246
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-08
Last Update Date:2021-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMSW0092391041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical