Provider Demographics
NPI:1568087575
Name:BRANTLEY, JOHN KENNETH JR (MS LPC)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:KENNETH
Last Name:BRANTLEY
Suffix:JR
Gender:M
Credentials:MS LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1808 WILLOW BRANCH LN NW
Mailing Address - Street 2:
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30152-4558
Mailing Address - Country:US
Mailing Address - Phone:404-747-3018
Mailing Address - Fax:
Practice Address - Street 1:1301 SHILOH RD NW STE 450
Practice Address - Street 2:
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30144-7152
Practice Address - Country:US
Practice Address - Phone:404-747-3018
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-15
Last Update Date:2020-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA03934101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional