Organization
BRANDI TANNER, PH.D., LLC
Active
Other names
Lightway Psychological Services
Organization subpart
No
Provider details
NPI number
Authorized official
BRANDI TANNER PH.D. (OWNER)
(404) 491-1684
Entity
Organization
Contact information
Practice address
2801 BUFORD HWY NE STE 503, BROOKHAVEN, GA 30329-2137
(404) 491-1684
(844) 646-0336
Mailing address
2801 BUFORD HWY NE STE 503, BROOKHAVEN, GA 30329-2137
(404) 491-1684
(844) 646-0336
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
—
—
103TC0700X
Clinical Psychologist
Primary
—
—
103TS0200X
School Psychologist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003151503C
—
GA
Enumeration date
01/09/2018
Last updated
01/09/2018
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