Provider Demographics
NPI:1740563873
Name:OWENS, BROOKE (LPC)
Entity Type:Individual
Prefix:
First Name:BROOKE
Middle Name:
Last Name:OWENS
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 1:57 MOUNTAIN VIEW DR
Mailing Address - Street 2:
Mailing Address - City:ROCKMART
Mailing Address - State:GA
Mailing Address - Zip Code:30153-1536
Mailing Address - Country:US
Mailing Address - Phone:770-265-3344
Mailing Address - Fax:
Practice Address - Street 1:1301 SHILOH RD NW
Practice Address - Street 2:STE 710
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30144-7147
Practice Address - Country:US
Practice Address - Phone:770-792-0079
Practice Address - Fax:888-394-1986
Is Sole Proprietor?:No
Enumeration Date:2011-09-26
Last Update Date:2011-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC005312101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional