Healthcare Provider Details

I. General information

NPI: 1437414281
Provider Name (Legal Business Name): VALERIE AYANA BRENNAN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2012
Last Update Date: 09/09/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14TH MEDICAL GROUP 201 INDEPENDENCE DRIVE
COLUMBUS MS
39710
US

IV. Provider business mailing address

14TH MEDICAL GROUP 201 INDEPENDENCE DRIVE
COLUMBUS AFB MS
39701
US

V. Phone/Fax

Practice location:
  • Phone: 203-932-5711
  • Fax:
Mailing address:
  • Phone: 662-434-2273
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: