Provider Demographics
NPI:1265853956
Name:CARLSON, BRANDY MOSS (LICSW-S, RPT-S)
Entity type:Individual
Prefix:
First Name:BRANDY
Middle Name:MOSS
Last Name:CARLSON
Suffix:
Gender:
Credentials:LICSW-S, RPT-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:512 MEADOW RIDGE CIR
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35242-2978
Mailing Address - Country:US
Mailing Address - Phone:972-839-6262
Mailing Address - Fax:
Practice Address - Street 1:512 MEADOW RIDGE CIR
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35242-2978
Practice Address - Country:US
Practice Address - Phone:972-839-6262
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-23
Last Update Date:2025-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL4387C101YM0800X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health