Provider Demographics
NPI:1568131381
Name:GAINES, BREON (LGPC)
Entity type:Individual
Prefix:
First Name:BREON
Middle Name:
Last Name:GAINES
Suffix:
Gender:F
Credentials:LGPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4766 LAUREL WALK
Mailing Address - Street 2:
Mailing Address - City:DUNWOODY
Mailing Address - State:GA
Mailing Address - Zip Code:30338-4751
Mailing Address - Country:US
Mailing Address - Phone:504-554-0205
Mailing Address - Fax:
Practice Address - Street 1:1905 WOODSTOCK RD STE 3250
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30075-5622
Practice Address - Country:US
Practice Address - Phone:678-249-0072
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-07
Last Update Date:2024-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health