Provider Demographics
NPI:1508531914
Name:BROWN, THOMAS (MS, NCC, LPC)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:
Last Name:BROWN
Suffix:
Gender:M
Credentials:MS, NCC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:131 MORNINGVIEW LN
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:GA
Mailing Address - Zip Code:30228-3085
Mailing Address - Country:US
Mailing Address - Phone:678-343-1219
Mailing Address - Fax:
Practice Address - Street 1:131 MORNINGVIEW LN
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:GA
Practice Address - Zip Code:30228-3085
Practice Address - Country:US
Practice Address - Phone:678-343-1219
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-09
Last Update Date:2021-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC012311101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA7777Medicaid