Provider Demographics
NPI:1629529581
Name:SPAULDING, BRANDI
Entity Type:Individual
Prefix:DR
First Name:BRANDI
Middle Name:
Last Name:SPAULDING
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 1:2157 FIRSTENBERGER RD
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:OH
Mailing Address - Zip Code:43302-8792
Mailing Address - Country:US
Mailing Address - Phone:740-360-7811
Mailing Address - Fax:
Practice Address - Street 1:2157 FIRSTENBERGER RD
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:OH
Practice Address - Zip Code:43302-8792
Practice Address - Country:US
Practice Address - Phone:740-360-7811
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-17
Last Update Date:2023-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH151110101YA0400X
OH111510101YA0400X
103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH151110OtherLICDC