Provider Demographics
NPI:1740373711
Name:BRANNEN, VILDA STONE (MS, LPC)
Entity type:Individual
Prefix:
First Name:VILDA
Middle Name:STONE
Last Name:BRANNEN
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1640 POWERS FERRY RD SE, 16-100
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30067-5491
Mailing Address - Country:US
Mailing Address - Phone:404-310-6120
Mailing Address - Fax:770-952-2878
Practice Address - Street 1:1640 POWERS FERRY RD SE, 16-100
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30067-5491
Practice Address - Country:US
Practice Address - Phone:404-310-6120
Practice Address - Fax:770-952-2878
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2017-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC004368101YP2500X
NC4971101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional