Basic Information
| Provider Information | |||||||||
| NPI: | 1912271578 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | JOHNSON | ||||||||
| FirstName: | BRANDY | ||||||||
| MiddleName: | L. | ||||||||
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| Credential: | LPC | ||||||||
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| Mailing Information | |||||||||
| Address1: | P.O. BOX 1001 | ||||||||
| Address2: | |||||||||
| City: | GUNTERSVILLE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 35976 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2565828880 | ||||||||
| FaxNumber: | 2565828890 | ||||||||
| Practice Location | |||||||||
| Address1: | 1612 RAILROAD AVENUE | ||||||||
| Address2: | |||||||||
| City: | GUNTERSVILLE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 35976 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2565828880 | ||||||||
| FaxNumber: | 2565828890 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/29/2012 | ||||||||
| LastUpdateDate: | 09/27/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | 2806 | AL | Y | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
ID Information
| ID | Type | State | Issuer | Description | 339025055 | 05 | AL | MEDICAID |