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General NPI Number Information
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NPI Number | 1760993984
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Entity Type | Individual
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Provider Name | CAROLINE M. BRACKETTE PH.D., LPC, ACS
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Gender | Female
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Dates
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Enumeration Date | 10/15/2017
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Last Update Date | 09/13/2019
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Provider Practice Location Address
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Address Line | 2002 SUMMIT BLVD STE 300
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City | BROOKHAVEN
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State | GA
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Zip | 30319
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Country | US
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Telephone | 404-303-1864
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Fax |
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Provider Business Mailing Address
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Address Line | 2002 SUMMIT BLVD STE 300
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City | BROOKHAVEN
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State | GA
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Zip | 30319-6422
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Country | US
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Telephone |
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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 | 101Y00000X
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Taxonomy Name | Counselor
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License Number | LPC005580
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | LPC005580
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License Number State | GA
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Taxonomy #3
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Taxonomy Code | 101YS0200X
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Taxonomy Name | School Counselor
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License Number | 867988
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License Number State | GA
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Taxonomy #4
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | LPC005580
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License Number State | GA
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