Provider Demographics
NPI:1811031669
Name:PRINTUP, BRANDON HAROLD (LPC)
Entity Type:Individual
Prefix:MR
First Name:BRANDON
Middle Name:HAROLD
Last Name:PRINTUP
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:939 PORTER RD
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30032-1729
Mailing Address - Country:US
Mailing Address - Phone:404-292-9510
Mailing Address - Fax:
Practice Address - Street 1:1074 NORTH DECATUR RD
Practice Address - Street 2:SUITE 145
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30030
Practice Address - Country:US
Practice Address - Phone:770-918-6677
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-16
Last Update Date:2008-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA004266101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional