Provider Demographics
NPI:1922394311
Name:BRENNER, CATHY (LAPC)
Entity type:Individual
Prefix:
First Name:CATHY
Middle Name:
Last Name:BRENNER
Suffix:
Gender:F
Credentials:LAPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:131 N JEFFERSON ST NE
Mailing Address - Street 2:PO BOX 1827
Mailing Address - City:MILLEDGEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31061-5513
Mailing Address - Country:US
Mailing Address - Phone:478-445-4971
Mailing Address - Fax:478-445-2245
Practice Address - Street 1:131 N JEFFERSON ST NE
Practice Address - Street 2:
Practice Address - City:MILLEDGEVILLE
Practice Address - State:GA
Practice Address - Zip Code:31061-5513
Practice Address - Country:US
Practice Address - Phone:478-445-4971
Practice Address - Fax:478-445-2245
Is Sole Proprietor?:No
Enumeration Date:2011-06-23
Last Update Date:2011-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAPC00257101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAAPC00257OtherLAPC