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General NPI Number Information
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NPI Number | 1073608063
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Entity Type | Organization
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Legal Business Name | BRENDA KOPLAN,LCSW
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Dates
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Enumeration Date | 10/04/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 522 GREENWOOD STREET SUITE G
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City | BARNESVILLE
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State | GA
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Zip | 30224
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Country | US
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Telephone | 404-402-6132
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Fax | 770-228-4847
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Provider Business Mailing Address
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Address Line | 135 GROVE LANE
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City | GRIFFIN
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State | GA
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Zip | 30224
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Country | US
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Telephone | 404-402-6132
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Fax | 770-228-4847
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Authorized Official
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Title or Position | COUNSELOR/PSYCHOTHERAPIST
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Name | BRENDA JOYCE KOPLAN
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Credential | L.C.S.W.
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Telephone | 404-402-6132
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | #002666
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License Number State | GA
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