Provider Demographics
NPI:1235578451
Name:BRESHEARS, MARY KATHRYN (MS, LPC)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:KATHRYN
Last Name:BRESHEARS
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:
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Mailing Address - Street 1:127 CHURCH ST NE
Mailing Address - Street 2:SUITE 350
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30060-8637
Mailing Address - Country:US
Mailing Address - Phone:770-425-8275
Mailing Address - Fax:770-425-8276
Practice Address - Street 1:127 CHURCH ST NE
Practice Address - Street 2:SUITE 350
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060-8637
Practice Address - Country:US
Practice Address - Phone:770-425-8275
Practice Address - Fax:770-425-8276
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-20
Last Update Date:2013-06-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GALPC007254101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional