Provider Demographics
NPI:1427211846
Name:TRACHTENBROIT, LAURIE ANNE (LPC)
Entity Type:Individual
Prefix:MS
First Name:LAURIE
Middle Name:ANNE
Last Name:TRACHTENBROIT
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:MS
Other - First Name:LAURIE
Other - Middle Name:ANNE
Other - Last Name:KELLOGG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:OFFICE TOWER 550 PEACHTREE STREET NE SUITE 1577
Mailing Address - Street 2:C/O INSIGHT PSYCHOTHERAPY EMORY CRAWFORD LONG MEDICAL
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30308
Mailing Address - Country:US
Mailing Address - Phone:404-685-0226
Mailing Address - Fax:
Practice Address - Street 1:OFFICE TOWER 550 PEACHTREE STREET NE SUITE 1577
Practice Address - Street 2:C/O INSIGHT PSYCHOTHERAPY EMORY CRAWFORD LONG MEDICAL
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30308
Practice Address - Country:US
Practice Address - Phone:404-685-0226
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-07
Last Update Date:2008-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC003860101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor