Provider Demographics
NPI:1063869634
Name:JOSEPH, BRENNEN (LPC)
Entity type:Individual
Prefix:
First Name:BRENNEN
Middle Name:
Last Name:JOSEPH
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:BRENNEN
Other - Middle Name:
Other - Last Name:ORKIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPC
Mailing Address - Street 1:4549 CHAMBLEE DUNWOODY RD
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30338-6210
Mailing Address - Country:US
Mailing Address - Phone:404-276-0670
Mailing Address - Fax:
Practice Address - Street 1:4549 CHAMBLEE DUNWOODY RD
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30338-6210
Practice Address - Country:US
Practice Address - Phone:770-677-9436
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-24
Last Update Date:2021-08-13
Deactivation Date:2021-07-01
Deactivation Code:
Reactivation Date:2021-07-22
Provider Licenses
StateLicense IDTaxonomies
GALPC012164101YP2500X
101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional