Doctor Name: | DARIUS BRANNON |
NPI Number: | 1104295120 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | B.A., CADAC II |
License Number: | |
Business Practice Address: | 1110 W 5th Ave Gary, IN - 464021723 |
Business Phone Number: | 2198856424 |
Business Fax Number: | |
Mailing Address: | 1110 W 5th Ave, GARY |
State: | IN |
Postal Code: | 464021723 |
Phone Number: | 2198856424 |
Fax Number: | |
NPI Enumeration Date: | 09/21/2015 |
NPI Last Update Date: | 09/21/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YA0400X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IN |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Addiction (Substance Use Disorder) |
Taxonomy Definition: |