Provider Demographics
NPI:1609125806
Name:MCBRAYER, THOMAS CARROLL JR (LPC)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:CARROLL
Last Name:MCBRAYER
Suffix:JR
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Suffix:
Other - Last Name Type:
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Mailing Address - Street 1:210 WOODLAND DR
Mailing Address - Street 2:
Mailing Address - City:PEACHTREE CITY
Mailing Address - State:GA
Mailing Address - Zip Code:30269-1322
Mailing Address - Country:US
Mailing Address - Phone:770-632-5484
Mailing Address - Fax:
Practice Address - Street 1:6000 SHAKERAG HL
Practice Address - Street 2:SUITE 218
Practice Address - City:PEACHTREE CITY
Practice Address - State:GA
Practice Address - Zip Code:30269-6523
Practice Address - Country:US
Practice Address - Phone:770-632-1088
Practice Address - Fax:770-632-2088
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-04
Last Update Date:2012-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC000487101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor