Provider Demographics
NPI:1750626248
Name:HARRIS GOOLSBY, BRENDA (MS, MFT)
Entity type:Individual
Prefix:
First Name:BRENDA
Middle Name:
Last Name:HARRIS GOOLSBY
Suffix:
Gender:F
Credentials:MS, MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:291 PLANTATION CENTRE DR N
Mailing Address - Street 2:2204
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31210-9201
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6601 ZEBULON RD
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31220-7606
Practice Address - Country:US
Practice Address - Phone:478-477-3383
Practice Address - Fax:478-475-9492
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-10
Last Update Date:2012-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor