Healthcare Provider Details

I. General information

NPI: 1275449266
Provider Name (Legal Business Name): BREANNA WILSON ALC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2026
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1924 DAUPHIN ISLAND PKWY
MOBILE AL
36605-3004
US

IV. Provider business mailing address

7805 LANTERN WAY
MOBILE AL
36619-5359
US

V. Phone/Fax

Practice location:
  • Phone: 251-476-5733
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberALC04902
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberALC04902
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: