Provider Demographics
NPI:1912673377
Name:BRANDT, LAYLA NICOLE (LAPC)
Entity Type:Individual
Prefix:
First Name:LAYLA
Middle Name:NICOLE
Last Name:BRANDT
Suffix:
Gender:F
Credentials:LAPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6095 PINE MOUNTAIN RD NW STE 105
Mailing Address - Street 2:
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30152-3332
Mailing Address - Country:US
Mailing Address - Phone:678-217-7529
Mailing Address - Fax:770-966-8228
Practice Address - Street 1:6095 PINE MOUNTAIN RD NW STE 105
Practice Address - Street 2:
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30152-3332
Practice Address - Country:US
Practice Address - Phone:678-217-7529
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-17
Last Update Date:2023-11-28
Deactivation Date:2023-11-08
Deactivation Code:
Reactivation Date:2023-11-28
Provider Licenses
StateLicense IDTaxonomies
GAAPC007056101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health