Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | LPC002833 | GA |
N | 101YS0200X | School Counselor | 634508 | GA |
NPI | 1245460849 |
---|---|
Provider Name | Brian Alan Conner |
First Address | Newnan, GA 30263-1614 |
Second Address | Smyrna, GA 30080-6303 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/07/2009 |
Last Update Date | 21/07/2009 |