Provider Demographics
NPI:1245708064
Name:FELDMAN, BRIAN DANIEL (LPC, NCC, CCMHC)
Entity type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:DANIEL
Last Name:FELDMAN
Suffix:
Gender:M
Credentials:LPC, NCC, CCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:64 HICKORY WALK
Mailing Address - Street 2:
Mailing Address - City:HOSCHTON
Mailing Address - State:GA
Mailing Address - Zip Code:30548-2012
Mailing Address - Country:US
Mailing Address - Phone:770-609-9164
Mailing Address - Fax:877-344-7086
Practice Address - Street 1:2675 MALL OF GEORGIA BLVD STE 102
Practice Address - Street 2:
Practice Address - City:BUFORD
Practice Address - State:GA
Practice Address - Zip Code:30519-8783
Practice Address - Country:US
Practice Address - Phone:770-609-9164
Practice Address - Fax:877-344-7086
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-09
Last Update Date:2022-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAPC005473101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional