Colvin Jeffrey Brogdon, LPC, NCC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

LPC002957 Issued in GA

Practice address

113 Bascom CT Ste C
Columbus, GA 31909-2798

Phone

(706) 569-7254

Fax

(706) 569-9212

NPI assigned

Sep 20, 2006

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1158710400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1592956800000",
    "number": "1396843579",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13821 CROSS CREEK RD",
            "city": "UPATOI",
            "state": "GA",
            "postal_code": "318291802",
            "telephone_number": "706-569-9212",
            "fax_number": "706-569-9212"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "113 BASCOM CT STE C",
            "city": "COLUMBUS",
            "state": "GA",
            "postal_code": "319092798",
            "telephone_number": "706-569-7254",
            "fax_number": "706-569-9212"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BROGDON",
        "first_name": "COLVIN",
        "middle_name": "JEFFREY",
        "name_prefix": "Mr.",
        "credential": "LPC, NCC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-09-20",
        "last_updated": "2020-06-24",
        "certification_date": "2020-06-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "GA",
            "license": "LPC002957",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "576838803A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Professional Counselor in Columbus, GA
• Providers in Columbus, GA by specialty
• Professional Counselor in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 24, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.