Provider Demographics
NPI:1962279794
Name:BROWN, ERIC WENDELL (MS, LAPC)
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:WENDELL
Last Name:BROWN
Suffix:
Gender:M
Credentials:MS, LAPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2103 LANDSMERE DR SE
Mailing Address - Street 2:
Mailing Address - City:MABLETON
Mailing Address - State:GA
Mailing Address - Zip Code:30126-2966
Mailing Address - Country:US
Mailing Address - Phone:404-998-9298
Mailing Address - Fax:
Practice Address - Street 1:400 TECHNOLOGY CT SE
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:GA
Practice Address - Zip Code:30082-5237
Practice Address - Country:US
Practice Address - Phone:844-716-0956
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-12
Last Update Date:2024-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAPC009442101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional