Provider Demographics
NPI:1790363315
Name:MCDUFFIE, BRIAN PATRICK
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:PATRICK
Last Name:MCDUFFIE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8937 SPRING GRV N
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36695-5326
Mailing Address - Country:US
Mailing Address - Phone:850-420-0587
Mailing Address - Fax:
Practice Address - Street 1:5750 SOUTHLAND DR # A
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36693-3316
Practice Address - Country:US
Practice Address - Phone:251-450-2211
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-02
Last Update Date:2021-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL5185G104100000X
FLISW15297104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker