Healthcare Provider Details

I. General information

NPI: 1093263972
Provider Name (Legal Business Name): JIMMY HEATH BROWNING LPC, MAC, CBT, MRT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2016
Last Update Date: 04/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 BRAMPTON AVE STE N
STATESBORO GA
30458-0871
US

IV. Provider business mailing address

19 CHURCH ST
STATESBORO GA
30458-5385
US

V. Phone/Fax

Practice location:
  • Phone: 912-266-9094
  • Fax:
Mailing address:
  • Phone: 912-489-7590
  • Fax: 912-489-3877

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLPC008979
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPC0089979
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC008979
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: