Provider Demographics
NPI:1003411596
Name:BRANNOCK, CAROLINE (BA, BCABA)
Entity Type:Individual
Prefix:MRS
First Name:CAROLINE
Middle Name:
Last Name:BRANNOCK
Suffix:
Gender:F
Credentials:BA, BCABA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4614 WAVERLY ROAD
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25704
Mailing Address - Country:US
Mailing Address - Phone:304-429-3287
Mailing Address - Fax:304-429-0024
Practice Address - Street 1:4614 WAVERLY ROAD
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25704
Practice Address - Country:US
Practice Address - Phone:304-429-3287
Practice Address - Fax:304-429-0024
Is Sole Proprietor?:No
Enumeration Date:2020-12-02
Last Update Date:2020-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV0-20-11462101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health