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General NPI Number Information
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NPI Number | 1487277976
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Entity Type | Individual
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Provider Name | MISS BREANNA VICTORIA STUBBS
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Gender | Female
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Dates
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Enumeration Date | 05/19/2020
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Last Update Date | 05/19/2020
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Provider Practice Location Address
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Address Line | 1226 ROYAL DR SW STE D
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City | CONYERS
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State | GA
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Zip | 30094-5926
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Country | US
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Telephone | 678-658-0645
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Fax |
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Provider Business Mailing Address
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Address Line | 7027 SETTERS WAY
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City | STONECREST
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State | GA
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Zip | 30038-7502
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Country | US
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Telephone | 863-999-3910
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Fax |
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | APC006441
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License Number State | GA
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