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General NPI Number Information
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NPI Number | 1366931008
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Entity Type | Organization
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Legal Business Name | BRAD W ERLANDSON LLC
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Dates
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Enumeration Date | 05/08/2018
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Last Update Date | 01/22/2019
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Provider Practice Location Address
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Address Line | 162 PROSPECT PL
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City | ALPHARETTA
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State | GA
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Zip | 30005-5445
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Country | US
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Telephone | 678-340-6788
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Fax |
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Provider Business Mailing Address
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Address Line | 160 PROSPECT PL
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City | ALPHARETTA
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State | GA
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Zip | 30005-5445
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Country | US
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Telephone | 678-653-4273
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Fax | 770-406-8872
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Authorized Official
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Title or Position | OWNER
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Name | BRAD ERLANDSON
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Credential | LPC
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Telephone | 678-653-4273
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | LPC008627
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License Number State | GA
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