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General NPI Number Information
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NPI Number | 1407211139
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Entity Type | Individual
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Provider Name | TRISHA BROWN
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Gender | Female
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Dates
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Enumeration Date | 12/22/2015
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Last Update Date | 11/08/2021
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Provider Practice Location Address
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Address Line | 4991 LONGVIEW WALK
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City | DECATUR
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State | GA
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Zip | 30035-4189
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Country | US
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Telephone | 470-588-7139
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Fax | 470-592-6077
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Provider Business Mailing Address
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Address Line | 2107 N DECATUR RD # 183
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City | DECATUR
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State | GA
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Zip | 30033-5305
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Country | US
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Telephone | 470-588-7139
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Fax | 470-592-6077
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | LPC008409
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License Number State | GA
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