Individual
DR. LOUISA PORTER BRANSCOMB
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PH.D.
Contact information
Practice address
5 S PUBLIC SQ, SUITE 103, CARTERSVILLE, GA 30120-3348
(678) 721-0103
(770) 382-0023
Mailing address
150 BOWEN RD NE, WHITE, GA 30184-2026
(678) 721-0103
(770) 382-0023
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
PSY001315
GA
103TC0700X
Clinical Psychologist
PY00002224
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11410766
CAQH
GA
Enumeration date
01/03/2007
Last updated
07/08/2007
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