Provider Demographics
NPI:1508204207
Name:BROWNLEE, ANTWAN (LPC)
Entity Type:Individual
Prefix:
First Name:ANTWAN
Middle Name:
Last Name:BROWNLEE
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5049 MEADOW TRCE
Mailing Address - Street 2:
Mailing Address - City:FAIRBURN
Mailing Address - State:GA
Mailing Address - Zip Code:30213-4282
Mailing Address - Country:US
Mailing Address - Phone:770-309-6226
Mailing Address - Fax:
Practice Address - Street 1:5049 MEADOW TRCE
Practice Address - Street 2:
Practice Address - City:FAIRBURN
Practice Address - State:GA
Practice Address - Zip Code:30213-4282
Practice Address - Country:US
Practice Address - Phone:770-309-6226
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-05
Last Update Date:2013-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA007283101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA462253551OtherTAX ID