Basic Information
| Provider Information | |||||||||
| NPI: | 1811031669 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PRINTUP | ||||||||
| FirstName: | BRANDON | ||||||||
| MiddleName: | HAROLD | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | L.P.C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 939 PORTER RD | ||||||||
| Address2: | |||||||||
| City: | DECATUR | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300321729 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4042929510 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1074 NORTH DECATUR RD | ||||||||
| Address2: | SUITE 145 | ||||||||
| City: | DECATUR | ||||||||
| State: | GA | ||||||||
| PostalCode: | 30030 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7709186677 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/16/2007 | ||||||||
| LastUpdateDate: | 10/22/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | 004266 | GA | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.