Provider Demographics
NPI:1124716865
Name:SCARBORO, BRANDON CHRISTOPHER (LCSW, CMAC)
Entity type:Individual
Prefix:
First Name:BRANDON
Middle Name:CHRISTOPHER
Last Name:SCARBORO
Suffix:
Gender:M
Credentials:LCSW, CMAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2117 SYLVAN LAKE DR
Mailing Address - Street 2:
Mailing Address - City:GROVETOWN
Mailing Address - State:GA
Mailing Address - Zip Code:30813-5851
Mailing Address - Country:US
Mailing Address - Phone:706-466-9474
Mailing Address - Fax:
Practice Address - Street 1:2117 SYLVAN LAKE DR
Practice Address - Street 2:
Practice Address - City:GROVETOWN
Practice Address - State:GA
Practice Address - Zip Code:30813-5851
Practice Address - Country:US
Practice Address - Phone:706-466-9474
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-01
Last Update Date:2023-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0211101YA0400X
GACSW0082741041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)