Provider Demographics
NPI:1164090684
Name:WEAVER, BRETT (LPC)
Entity Type:Individual
Prefix:
First Name:BRETT
Middle Name:
Last Name:WEAVER
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 1:2408 LEE STREET RD
Mailing Address - Street 2:
Mailing Address - City:AMERICUS
Mailing Address - State:GA
Mailing Address - Zip Code:31709-9249
Mailing Address - Country:US
Mailing Address - Phone:806-367-2176
Mailing Address - Fax:
Practice Address - Street 1:2408 LEE STREET RD
Practice Address - Street 2:
Practice Address - City:AMERICUS
Practice Address - State:GA
Practice Address - Zip Code:31709-9249
Practice Address - Country:US
Practice Address - Phone:806-367-2176
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-11
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA8771101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health