Provider Demographics
NPI:1427702299
Name:BROWN, LAURA TENNILLE (LPC)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:TENNILLE
Last Name:BROWN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3341 GULFSTREAM LN
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30062-5541
Mailing Address - Country:US
Mailing Address - Phone:214-364-7806
Mailing Address - Fax:
Practice Address - Street 1:3341 GULFSTREAM LN
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30062-5541
Practice Address - Country:US
Practice Address - Phone:214-364-7806
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-09
Last Update Date:2022-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC012435101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional