Provider Demographics
NPI:1841446663
Name:BRANNON, NANNETTE M (LPC)
Entity type:Individual
Prefix:MS
First Name:NANNETTE
Middle Name:M
Last Name:BRANNON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1712 OSBORNE RD
Mailing Address - Street 2:SUITE L
Mailing Address - City:SAINT MARYS
Mailing Address - State:GA
Mailing Address - Zip Code:31558-9102
Mailing Address - Country:US
Mailing Address - Phone:912-882-3800
Mailing Address - Fax:912-882-3303
Practice Address - Street 1:1712 OSBORNE ROAD
Practice Address - Street 2:SUITE L
Practice Address - City:ST. MARYS
Practice Address - State:GA
Practice Address - Zip Code:31558
Practice Address - Country:US
Practice Address - Phone:912-510-0669
Practice Address - Fax:912-510-0754
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-12
Last Update Date:2017-01-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GAAPC001552101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional