Provider Demographics
NPI:1598990350
Name:BRUTUS, ANGEL L (LPC, CRC)
Entity Type:Individual
Prefix:
First Name:ANGEL
Middle Name:L
Last Name:BRUTUS
Suffix:
Gender:F
Credentials:LPC, CRC
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 1139
Mailing Address - Street 2:
Mailing Address - City:LITHONIA
Mailing Address - State:GA
Mailing Address - Zip Code:30058-1042
Mailing Address - Country:US
Mailing Address - Phone:404-992-0071
Mailing Address - Fax:678-615-3722
Practice Address - Street 1:6020 IDLEWOOD TRCE
Practice Address - Street 2:
Practice Address - City:LITHONIA
Practice Address - State:GA
Practice Address - Zip Code:30038-6267
Practice Address - Country:US
Practice Address - Phone:404-992-0071
Practice Address - Fax:678-615-3722
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-22
Last Update Date:2009-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC005112101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional