Provider Demographics
NPI:1942278965
Name:MARTIN, BRINDA ANN (LPC)
Entity Type:Individual
Prefix:MRS
First Name:BRINDA
Middle Name:ANN
Last Name:MARTIN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:MISS
Other - First Name:BRINDA
Other - Middle Name:ANN
Other - Last Name:PRESCOTT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:770 GREISON TRAIL
Mailing Address - Street 2:SUITE A
Mailing Address - City:NEWNAN
Mailing Address - State:GA
Mailing Address - Zip Code:30263-6401
Mailing Address - Country:US
Mailing Address - Phone:770-683-3221
Mailing Address - Fax:
Practice Address - Street 1:770 GREISON TRL
Practice Address - Street 2:SUITE A
Practice Address - City:NEWNAN
Practice Address - State:GA
Practice Address - Zip Code:30263-6408
Practice Address - Country:US
Practice Address - Phone:770-683-9096
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC004280101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor