Provider Demographics
NPI:1982335303
Name:BRAST, LEAH (MS, ALC)
Entity Type:Individual
Prefix:
First Name:LEAH
Middle Name:
Last Name:BRAST
Suffix:
Gender:F
Credentials:MS, ALC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3413 SHEFFIELD DR
Mailing Address - Street 2:
Mailing Address - City:VESTAVIA
Mailing Address - State:AL
Mailing Address - Zip Code:35223-2239
Mailing Address - Country:US
Mailing Address - Phone:205-420-1851
Mailing Address - Fax:
Practice Address - Street 1:3420 2ND AVE N
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35222-1216
Practice Address - Country:US
Practice Address - Phone:205-323-5878
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-17
Last Update Date:2022-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALC3965A101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional