Provider Demographics
NPI:1720767817
Name:MERCHANT, BRANDI RENEE
Entity Type:Individual
Prefix:
First Name:BRANDI
Middle Name:RENEE
Last Name:MERCHANT
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 1:260 CYPRESS CREEK DR NE
Mailing Address - Street 2:
Mailing Address - City:LUDOWICI
Mailing Address - State:GA
Mailing Address - Zip Code:31316-3132
Mailing Address - Country:US
Mailing Address - Phone:409-553-9218
Mailing Address - Fax:
Practice Address - Street 1:260 CYPRESS CREEK DR NE
Practice Address - Street 2:
Practice Address - City:LUDOWICI
Practice Address - State:GA
Practice Address - Zip Code:31316-3132
Practice Address - Country:US
Practice Address - Phone:409-553-9218
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-14
Last Update Date:2023-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA014009101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health