Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | LPC010754 | GA |
N | 101YS0200X | School Counselor | APC005357 | GA |
NPI | 1104230184 |
---|---|
Provider Name | Mrs. Brandy Kaye Nicholson |
First Address | Acworth, GA 30101-5278 |
Second Address | Acworth, GA 30101-5278 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/06/2014 |
Last Update Date | 27/01/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1104230184 | (05) | GA |