Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | LPC003392 | GA |
N | 103G00000X | Clinical Psychologist | NONE | GA |
N | 103TC0700X | Clinical Psychologist | NONE | GA |
NPI | 1003055104 |
---|---|
Provider Name | Dr. Lashawn Faison-Bradley |
First Address | Douglasville, GA 30134-6937 |
Second Address | Hiram, GA 30141-6008 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/02/2009 |
Last Update Date | 17/03/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
003159462A | (05) | GA |
003187089A | (05) | GA |