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General NPI Number Information
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NPI Number | 1497201719
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Entity Type | Organization
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Legal Business Name | BRANTLEY COUNSELING LLC
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Dates
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Enumeration Date | 08/28/2016
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Last Update Date | 01/24/2024
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Provider Practice Location Address
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Address Line | 518 COUPER RD
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City | WAYNESVILLE
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State | GA
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Zip | 31566-3438
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Country | US
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Telephone | 912-292-6087
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Fax | 912-244-9914
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Provider Business Mailing Address
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Address Line | PO BOX 254
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City | WAYNESVILLE
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State | GA
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Zip | 31566-0254
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Country | US
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Telephone | 912-292-6087
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Fax | 912-244-9914
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Authorized Official
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Title or Position | SOLE MEMBER
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Name | CRYSTAL J WRIGHT
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Credential | LCSW
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Telephone | 912-292-6087
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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 | LCSW 34536
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License Number State | ID
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