Healthcare Provider Details

I. General information

NPI: 1487277976
Provider Name (Legal Business Name): MRS. BREANNA VICTORIA STUBBS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2020
Last Update Date: 04/01/2026
Certification Date: 04/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2220 N DRUID HILLS RD NE
ATLANTA GA
30329-3117
US

IV. Provider business mailing address

7027 SETTERS WAY
STONECREST GA
30038-7502
US

V. Phone/Fax

Practice location:
  • Phone: 404-785-9584
  • Fax:
Mailing address:
  • Phone: 863-999-3910
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC012874
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: