Provider Demographics
NPI:1295023265
Name:BROGDON-HARRIS, LORRAINE (LPC)
Entity Type:Individual
Prefix:
First Name:LORRAINE
Middle Name:
Last Name:BROGDON-HARRIS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2886 SANDY PLAINS RD # 968082
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30066-9998
Mailing Address - Country:US
Mailing Address - Phone:770-325-2273
Mailing Address - Fax:
Practice Address - Street 1:120 S PARK SQ NE STE 203
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060-8631
Practice Address - Country:US
Practice Address - Phone:770-325-2273
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-12
Last Update Date:2020-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC006433101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health