Healthcare Provider Details

I. General information

NPI: 1205545803
Provider Name (Legal Business Name): BRENNA NORRIS LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/22/2022
Last Update Date: 10/13/2024
Certification Date: 10/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

574 AZALEA RD STE 125
MOBILE AL
36609-1517
US

IV. Provider business mailing address

574 AZALEA RD STE 125
MOBILE AL
36609-1517
US

V. Phone/Fax

Practice location:
  • Phone: 251-289-1985
  • Fax:
Mailing address:
  • Phone: 229-412-7411
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number5975C
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: