Provider Demographics
NPI:1699430579
Name:BRATHWAITE, OLINFRA
Entity type:Individual
Prefix:
First Name:OLINFRA
Middle Name:
Last Name:BRATHWAITE
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 1:11365 HIGHWAY 231 431 N STE B
Mailing Address - Street 2:
Mailing Address - City:MERIDIANVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35759-2147
Mailing Address - Country:US
Mailing Address - Phone:256-850-4091
Mailing Address - Fax:
Practice Address - Street 1:11365 HIGHWAY 231 431 N STE B
Practice Address - Street 2:
Practice Address - City:MERIDIANVILLE
Practice Address - State:AL
Practice Address - Zip Code:35759-2147
Practice Address - Country:US
Practice Address - Phone:256-850-4091
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-04
Last Update Date:2021-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor