Provider Demographics
NPI:1154576700
Name:REA, BRANDY SPENCER (LPC)
Entity type:Individual
Prefix:MRS
First Name:BRANDY
Middle Name:SPENCER
Last Name:REA
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:502 S CHURCH AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:MS
Mailing Address - Zip Code:39350-2503
Mailing Address - Country:US
Mailing Address - Phone:601-562-6906
Mailing Address - Fax:601-207-7720
Practice Address - Street 1:502 S CHURCH AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:MS
Practice Address - Zip Code:39350-2503
Practice Address - Country:US
Practice Address - Phone:601-562-6906
Practice Address - Fax:601-207-7720
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-24
Last Update Date:2016-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS1379101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional