Provider Demographics
NPI:1245460849
Name:CONNER, BRIAN ALAN (LPC)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:ALAN
Last Name:CONNER
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 1:20 WILLOW DR
Mailing Address - Street 2:
Mailing Address - City:NEWNAN
Mailing Address - State:GA
Mailing Address - Zip Code:30263-1614
Mailing Address - Country:US
Mailing Address - Phone:678-516-7725
Mailing Address - Fax:770-253-4144
Practice Address - Street 1:4015 S COBB DR SE
Practice Address - Street 2:SUITE 210
Practice Address - City:SMYRNA
Practice Address - State:GA
Practice Address - Zip Code:30080-6303
Practice Address - Country:US
Practice Address - Phone:678-516-7725
Practice Address - Fax:770-253-4144
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-17
Last Update Date:2009-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC002833101YP2500X
GA634508101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool