Provider Demographics
NPI:1124658208
Name:STEPHENS, BRYAN GERARD (LPC)
Entity type:Individual
Prefix:
First Name:BRYAN
Middle Name:GERARD
Last Name:STEPHENS
Suffix:
Gender:
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 MARQUIS WAY
Mailing Address - Street 2:
Mailing Address - City:MORROW
Mailing Address - State:GA
Mailing Address - Zip Code:30260-4148
Mailing Address - Country:US
Mailing Address - Phone:678-964-1868
Mailing Address - Fax:
Practice Address - Street 1:202 MARQUIS WAY
Practice Address - Street 2:
Practice Address - City:MORROW
Practice Address - State:GA
Practice Address - Zip Code:30260-4148
Practice Address - Country:US
Practice Address - Phone:678-964-1868
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-17
Last Update Date:2025-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA011142101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health