Provider Demographics
NPI:1699140053
Name:BREWER, KRISTY LARKIN (LCSW, PHD)
Entity type:Individual
Prefix:
First Name:KRISTY
Middle Name:LARKIN
Last Name:BREWER
Suffix:
Gender:F
Credentials:LCSW, PHD
Other - Prefix:
Other - First Name:KRISTY
Other - Middle Name:
Other - Last Name:LARKIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3870 PEACHTREE INDUSTRIAL BLVD # 340-312
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30096-1422
Mailing Address - Country:US
Mailing Address - Phone:678-744-5369
Mailing Address - Fax:770-446-5643
Practice Address - Street 1:3870 PEACHTREE INDUSTRIAL BLVD # 340-312
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30096-1422
Practice Address - Country:US
Practice Address - Phone:678-744-5369
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-09
Last Update Date:2022-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0056341041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical