Provider Demographics
NPI:1821496589
Name:BROGDON, CHRISTOPHER JONATHAN (LAPC)
Entity Type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:JONATHAN
Last Name:BROGDON
Suffix:
Gender:M
Credentials:LAPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2450 ATLANTA HWY
Mailing Address - Street 2:UNIT#1403
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30040-8099
Mailing Address - Country:US
Mailing Address - Phone:678-722-1031
Mailing Address - Fax:
Practice Address - Street 1:2450 ATLANTA HWY
Practice Address - Street 2:UNIT#1403
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30040-8099
Practice Address - Country:US
Practice Address - Phone:678-722-1031
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-12-12
Last Update Date:2014-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAPC004641101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional