Provider Demographics
NPI:1275075707
Name:ALLEN, BRANNON (LPC, CCTP, NCC)
Entity Type:Individual
Prefix:
First Name:BRANNON
Middle Name:
Last Name:ALLEN
Suffix:
Gender:F
Credentials:LPC, CCTP, NCC
Other - Prefix:
Other - First Name:BRANNON
Other - Middle Name:
Other - Last Name:CABANISS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1 BALTIMORE PL NW STE 360
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30308-2132
Mailing Address - Country:US
Mailing Address - Phone:404-341-7239
Mailing Address - Fax:
Practice Address - Street 1:1 BALTIMORE PL NW STE 360
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30308-2132
Practice Address - Country:US
Practice Address - Phone:404-341-7239
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-15
Last Update Date:2022-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAPC005680101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional