Provider Demographics
NPI:1801229067
Name:BRANNON, BRENDA JAMES (LPC)
Entity type:Individual
Prefix:
First Name:BRENDA
Middle Name:JAMES
Last Name:BRANNON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:134 N ALEXANDER CREEK RD
Mailing Address - Street 2:
Mailing Address - City:NEWNAN
Mailing Address - State:GA
Mailing Address - Zip Code:30263-3577
Mailing Address - Country:US
Mailing Address - Phone:770-719-5467
Mailing Address - Fax:770-719-5468
Practice Address - Street 1:500 LANIER AVE W
Practice Address - Street 2:MAGNOLIA OFFICE PARK, SUITE 606A OFFICE # 7
Practice Address - City:FAYETTEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30214-7636
Practice Address - Country:US
Practice Address - Phone:770-719-5467
Practice Address - Fax:770-719-5468
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-12
Last Update Date:2013-08-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GALPC007426101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional