Healthcare Provider Details

I. General information

NPI: 1922394311
Provider Name (Legal Business Name): CATHY BRENNER LAPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2011
Last Update Date: 06/23/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

131 N JEFFERSON ST NE
MILLEDGEVILLE GA
31061-5513
US

IV. Provider business mailing address

131 N JEFFERSON ST NE PO BOX 1827
MILLEDGEVILLE GA
31061-5513
US

V. Phone/Fax

Practice location:
  • Phone: 478-445-4971
  • Fax: 478-445-2245
Mailing address:
  • Phone: 478-445-4971
  • Fax: 478-445-2245

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberAPC00257
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: