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General NPI Number Information
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NPI Number | 1558243642
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Entity Type | Organization
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Legal Business Name | BRUCKNER COUNSELING
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Dates
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Enumeration Date | 07/22/2025
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Last Update Date | 07/22/2025
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Provider Practice Location Address
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Address Line | 3651 MARS HILL RD STE 500B
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City | WATKINSVILLE
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State | GA
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Zip | 30677-5988
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Country | US
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Telephone | 706-223-0908
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Fax | 706-310-8113
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Provider Business Mailing Address
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Address Line | 3651 MARS HILL RD STE 500B
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City | WATKINSVILLE
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State | GA
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Zip | 30677-5988
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Country | US
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Telephone | 706-223-0908
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Fax | 706-310-8113
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Authorized Official
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Title or Position | PROVIDER
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Name | SHANNON BRUCKNER
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Credential | LCSW
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Telephone | 706-340-6944
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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 |
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License Number State |
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