Provider Demographics
NPI:1447886338
Name:BRISBOIS, SARA BETH (APC)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:BETH
Last Name:BRISBOIS
Suffix:
Gender:F
Credentials:APC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3506 BELL LN
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30507-8984
Mailing Address - Country:US
Mailing Address - Phone:770-561-2169
Mailing Address - Fax:
Practice Address - Street 1:1247 TUSCANY DR
Practice Address - Street 2:SUITE B-1
Practice Address - City:BRASELTON
Practice Address - State:GA
Practice Address - Zip Code:30517
Practice Address - Country:US
Practice Address - Phone:470-239-1347
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-23
Last Update Date:2022-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAPC006076101YP2500X
GALPC012012101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional