Provider Demographics
NPI:1366016982
Name:BIRDSALL, BRENDA KAY
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:KAY
Last Name:BIRDSALL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:183 OLD TURNPIKE RD
Mailing Address - Street 2:
Mailing Address - City:MILLS RIVER
Mailing Address - State:NC
Mailing Address - Zip Code:28759-8776
Mailing Address - Country:US
Mailing Address - Phone:855-945-7788
Mailing Address - Fax:
Practice Address - Street 1:183 OLD TURNPIKE RD
Practice Address - Street 2:
Practice Address - City:MILLS RIVER
Practice Address - State:NC
Practice Address - Zip Code:28759-8776
Practice Address - Country:US
Practice Address - Phone:855-945-7788
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-18
Last Update Date:2021-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCLCAS-27063101YA0400X
NCA16247101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)