Doctor Name: | MRS. O ANITA BRACKETT |
NPI Number: | 1780982249 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LPC006323 |
License Number: | LPC006323 |
Business Practice Address: | 1419 Washington St Ste 212 Clarkesville, GA - 305235430 |
Business Phone Number: | 7068098601 |
Business Fax Number: | 7068655358 |
Mailing Address: | 160 Three Sisters Trl, CLEVELAND |
State: | GA |
Postal Code: | 305287289 |
Phone Number: | 7068098601 |
Fax Number: | 7068655358 |
NPI Enumeration Date: | 03/08/2011 |
NPI Last Update Date: | 03/08/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YP2500X |
License Number: | LPC006323 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | GA |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Professional |
Taxonomy Definition: |