1407989502 NPI number — BRANDI CELESTE RUTAN LCSW

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1407989502 NPI number — BRANDI CELESTE RUTAN LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RUTAN
Provider First Name:
BRANDI
Provider Middle Name:
CELESTE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
COFFEY
Provider Other First Name:
BRANDI
Provider Other Middle Name:
CELESTE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1407989502
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/06/2026
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
40 TOWN SQ UNIT H
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BLAIRSVILLE
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30512-8503
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
706-781-1409
Provider Business Mailing Address Fax Number:
706-946-2044

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
40 TOWN SQ UNIT H
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BLAIRSVILLE
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30512-8503
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
706-781-1409
Provider Business Practice Location Address Fax Number:
706-946-2044
Provider Enumeration Date:
03/14/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  C009934 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 104100000X , with the licence number: 11720 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 104100000X , with the licence number: C009934 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1041C0700X , with the licence number: CSW005851 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: CSW005851 . This is a "LICENSED CLINICAL SOCIAL WORKER" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 11720 . This is a "LICENSED INDEPENDENT SOCIAL WORKER" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".
  • Identifier: C009934 . This is a "LICENSED CLINICAL SOCIAL WORKER" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".




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