Provider Demographics
NPI:1508248907
Name:BROWN, PHAEDRA (MED, LPC)
Entity Type:Individual
Prefix:MS
First Name:PHAEDRA
Middle Name:
Last Name:BROWN
Suffix:
Gender:F
Credentials:MED, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 PHOENIX BLVD STE 128
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30349-5555
Mailing Address - Country:US
Mailing Address - Phone:404-947-8951
Mailing Address - Fax:
Practice Address - Street 1:1800 PHOENIX BLVD STE 128
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30349-5555
Practice Address - Country:US
Practice Address - Phone:404-947-8951
Practice Address - Fax:404-586-0102
Is Sole Proprietor?:No
Enumeration Date:2015-06-22
Last Update Date:2022-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003166269AMedicaid