Provider Demographics
NPI:1427771906
Name:LEBRANE, KEMOY
Entity type:Individual
Prefix:
First Name:KEMOY
Middle Name:
Last Name:LEBRANE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:580 BLUE RIDGE XING
Mailing Address - Street 2:
Mailing Address - City:EVANS
Mailing Address - State:GA
Mailing Address - Zip Code:30809-3612
Mailing Address - Country:US
Mailing Address - Phone:707-742-0502
Mailing Address - Fax:
Practice Address - Street 1:4400 COLUMBIA RD STE 100
Practice Address - Street 2:
Practice Address - City:MARTINEZ
Practice Address - State:GA
Practice Address - Zip Code:30907-4551
Practice Address - Country:US
Practice Address - Phone:706-310-5153
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-20
Last Update Date:2022-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMSW009842104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker