Healthcare Provider Details

I. General information

NPI: 1790918548
Provider Name (Legal Business Name): BRANDI BRADSHAW REEVES L.P.C., CAP, LMHP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/27/2009
Last Update Date: 01/24/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 WESTSIDE DR.
DOTHAN AK
36303
US

IV. Provider business mailing address

100 WESTSIDE DR
DOTHAN AL
36303-1908
US

V. Phone/Fax

Practice location:
  • Phone: 334-793-7237
  • Fax: 334-712-6256
Mailing address:
  • Phone: 334-793-7237
  • Fax: 334-712-6256

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number2760
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number50624
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2252
License Number StateAL

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: