Provider Demographics
NPI:1578322509
Name:BRANDNER, CHAD (CDCA)
Entity Type:Individual
Prefix:
First Name:CHAD
Middle Name:
Last Name:BRANDNER
Suffix:
Gender:M
Credentials:CDCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7837 N MAIN ST APT 11
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45415-2327
Mailing Address - Country:US
Mailing Address - Phone:513-291-6930
Mailing Address - Fax:
Practice Address - Street 1:4130 LINDEN AVE STE 185
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45432-3040
Practice Address - Country:US
Practice Address - Phone:937-723-9787
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-13
Last Update Date:2024-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCDCA.187503101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)