Provider Demographics
NPI:1952954844
Name:VERSEL, MAURISA BRODSKY (LPC)
Entity Type:Individual
Prefix:
First Name:MAURISA
Middle Name:BRODSKY
Last Name:VERSEL
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 1:1827 POWERS FERRY RD SE BLDG 22
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30339-5621
Mailing Address - Country:US
Mailing Address - Phone:770-953-4744
Mailing Address - Fax:
Practice Address - Street 1:3860 WINDERMERE PKWY STE 203
Practice Address - Street 2:
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30041-7034
Practice Address - Country:US
Practice Address - Phone:770-953-4744
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-19
Last Update Date:2019-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA003680101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional