Provider Demographics
NPI:1508989328
Name:BRISCOE, JANET ANN (LPC)
Entity Type:Individual
Prefix:
First Name:JANET
Middle Name:ANN
Last Name:BRISCOE
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:PO BOX 1892
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:GA
Mailing Address - Zip Code:31521-1892
Mailing Address - Country:US
Mailing Address - Phone:912-262-9200
Mailing Address - Fax:912-262-9214
Practice Address - Street 1:1615 REYNOLDS ST
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:GA
Practice Address - Zip Code:31520-6732
Practice Address - Country:US
Practice Address - Phone:912-262-9200
Practice Address - Fax:912-262-9214
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC003455101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional