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General NPI Number Information
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NPI Number | 1780198770
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Entity Type | Individual
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Provider Name | LEON EDWARD BRUNTY CADCII
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Gender | Male
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Dates
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Enumeration Date | 11/29/2017
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Last Update Date | 11/29/2017
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Provider Practice Location Address
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Address Line | 2607 LEDO RD
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City | ALBANY
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State | GA
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Zip | 31707-1211
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Country | US
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Telephone | 229-903-0022
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Fax | 229-903-0025
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Provider Business Mailing Address
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Address Line | 179 BRUNTY RD
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City | TY TY
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State | GA
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Zip | 31795-3601
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Country | US
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Telephone | 218-393-9723
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 770
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License Number State | GA
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