Provider Demographics
NPI:1497229918
Name:SANTIAGO, BRIAN (LPC)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:
Last Name:SANTIAGO
Suffix:
Gender:
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2440 SANDY PLAINS RD BLDG 25
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30066-7232
Mailing Address - Country:US
Mailing Address - Phone:770-971-9311
Mailing Address - Fax:770-726-0652
Practice Address - Street 1:1899 POWERS FERRY RD SE STE 250
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30339-8411
Practice Address - Country:US
Practice Address - Phone:678-831-0608
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-17
Last Update Date:2025-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA101YM0800X
GAAPC007891101YP2500X
GALPC015615101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health