Provider Demographics
NPI:1780745380
Name:BROYLES, JEANETTE L (LPC)
Entity type:Individual
Prefix:MS
First Name:JEANETTE
Middle Name:L
Last Name:BROYLES
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 PROFESSIONAL PARK
Mailing Address - Street 2:STE 302
Mailing Address - City:CARROLLTON
Mailing Address - State:GA
Mailing Address - Zip Code:30117-3872
Mailing Address - Country:US
Mailing Address - Phone:770-830-1300
Mailing Address - Fax:770-834-5469
Practice Address - Street 1:100 PROFESSIONAL PARK
Practice Address - Street 2:STE 302
Practice Address - City:CARROLLTON
Practice Address - State:GA
Practice Address - Zip Code:30117-3872
Practice Address - Country:US
Practice Address - Phone:770-830-1300
Practice Address - Fax:770-834-5469
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC 3427101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor