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General NPI Number Information
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NPI Number | 1346509080
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Entity Type | Organization
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Legal Business Name | THE BRANT CENTER
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Dates
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Enumeration Date | 05/15/2012
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Last Update Date | 05/15/2012
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Provider Practice Location Address
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Address Line | 1624 LAPSLEY ST
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City | SELMA
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State | AL
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Zip | 36701-5204
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Country | US
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Telephone | 334-300-1039
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Fax | 334-528-0174
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Provider Business Mailing Address
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Address Line | 1624 LAPSLEY ST P.O. BOX 2591
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City | SELMA
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State | AL
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Zip | 36701-5204
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Country | US
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Telephone | 334-300-1039
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Fax | 334-528-0174
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MR. DAVID MICHAEL BRANTLEY
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Credential | MASTERS SOCIAL WORK
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Telephone | 334-300-1039
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number |
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License Number State |
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