Provider Demographics
NPI:1083100044
Name:BRANTLEY, KATHERINE LONG (LICSW, PIP)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:LONG
Last Name:BRANTLEY
Suffix:
Gender:F
Credentials:LICSW, PIP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:442 LIGHTNESS DR
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:AL
Mailing Address - Zip Code:36832-5113
Mailing Address - Country:US
Mailing Address - Phone:205-482-1429
Mailing Address - Fax:
Practice Address - Street 1:318 N COLLEGE ST STE G
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:AL
Practice Address - Zip Code:36830-3815
Practice Address - Country:US
Practice Address - Phone:334-329-6063
Practice Address - Fax:334-329-6063
Is Sole Proprietor?:No
Enumeration Date:2018-07-02
Last Update Date:2018-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL3849C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical