Provider Demographics
NPI:1710283106
Name:BRUMMITT, LASHONDA TAKETISA (LPC, CCADC)
Entity Type:Individual
Prefix:MRS
First Name:LASHONDA
Middle Name:TAKETISA
Last Name:BRUMMITT
Suffix:
Gender:F
Credentials:LPC, CCADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4820 ARMOUR RD STE A2AND3
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31904-5296
Mailing Address - Country:US
Mailing Address - Phone:706-494-3722
Mailing Address - Fax:
Practice Address - Street 1:4820 ARMOUR RD STE A2AND3
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31904-5296
Practice Address - Country:US
Practice Address - Phone:706-494-3722
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-01
Last Update Date:2011-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA206072101YA0400X
GALPC004954101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)