Provider Demographics
NPI:1346509080
Name:THE BRANT CENTER
Entity Type:Organization
Organization Name:THE BRANT CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:BRANTLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MASTERS SOCIAL WORK
Authorized Official - Phone:334-300-1039
Mailing Address - Street 1:1624 LAPSLEY ST
Mailing Address - Street 2:P.O. BOX 2591
Mailing Address - City:SELMA
Mailing Address - State:AL
Mailing Address - Zip Code:36701-5204
Mailing Address - Country:US
Mailing Address - Phone:334-300-1039
Mailing Address - Fax:334-528-0174
Practice Address - Street 1:1624 LAPSLEY ST
Practice Address - Street 2:
Practice Address - City:SELMA
Practice Address - State:AL
Practice Address - Zip Code:36701-5204
Practice Address - Country:US
Practice Address - Phone:334-300-1039
Practice Address - Fax:334-528-0174
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-15
Last Update Date:2012-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty