Provider Demographics
NPI:1255504015
Name:BRITT, CHARLES L JR (MS, LPC, NCC, CPCS)
Entity Type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:L
Last Name:BRITT
Suffix:JR
Gender:M
Credentials:MS, LPC, NCC, CPCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:137 PROMINENCE CT STE 220
Mailing Address - Street 2:
Mailing Address - City:DAWSONVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30534-8939
Mailing Address - Country:US
Mailing Address - Phone:706-216-4735
Mailing Address - Fax:706-216-7909
Practice Address - Street 1:327 DAHLONEGA ST STE B302
Practice Address - Street 2:
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30040-2485
Practice Address - Country:US
Practice Address - Phone:678-571-7505
Practice Address - Fax:678-845-6286
Is Sole Proprietor?:No
Enumeration Date:2008-04-11
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC002826101YP2500X, 101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA539682443AMedicaid