Provider Demographics
NPI:1932465697
Name:STINSON, BRANDY SHAVON (LCSW)
Entity Type:Individual
Prefix:
First Name:BRANDY
Middle Name:SHAVON
Last Name:STINSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4345 REDGATE RD
Mailing Address - Street 2:
Mailing Address - City:NORCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:30093-3313
Mailing Address - Country:US
Mailing Address - Phone:404-276-6480
Mailing Address - Fax:
Practice Address - Street 1:4345 REDGATE RD
Practice Address - Street 2:
Practice Address - City:NORCROSS
Practice Address - State:GA
Practice Address - Zip Code:30093-3313
Practice Address - Country:US
Practice Address - Phone:404-276-6480
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-07
Last Update Date:2012-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0046341041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical