Provider Demographics
NPI:1760920359
Name:FORD, BRITTANY M (MSW LCSW LCAC CSAYC)
Entity Type:Individual
Prefix:MRS
First Name:BRITTANY
Middle Name:M
Last Name:FORD
Suffix:
Gender:F
Credentials:MSW LCSW LCAC CSAYC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5617 N COLLEGE AVE
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46220-3153
Mailing Address - Country:US
Mailing Address - Phone:317-804-4179
Mailing Address - Fax:
Practice Address - Street 1:5617 N COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46220-3153
Practice Address - Country:US
Practice Address - Phone:317-934-3772
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-03
Last Update Date:2024-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN87001743A101YA0400X
IN34008808A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)