Provider Demographics
NPI:1073001970
Name:OLIVE BRANCH FAMILY THERAPY, PLLC
Entity Type:Organization
Organization Name:OLIVE BRANCH FAMILY THERAPY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:LAWSON
Authorized Official - Last Name:MACHADO WORKMAN
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:919-428-7746
Mailing Address - Street 1:201 HOLLY SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:HOLLY SPRINGS
Mailing Address - State:NC
Mailing Address - Zip Code:27540-9023
Mailing Address - Country:US
Mailing Address - Phone:919-428-7746
Mailing Address - Fax:919-800-3949
Practice Address - Street 1:201 HOLLY SPRINGS RD
Practice Address - Street 2:
Practice Address - City:HOLLY SPRINGS
Practice Address - State:NC
Practice Address - Zip Code:27540-9023
Practice Address - Country:US
Practice Address - Phone:919-428-7746
Practice Address - Fax:919-800-3949
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-25
Last Update Date:2020-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1922106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC4541161060000OtherCIGNA
NC1255883385OtherBLUE CROSS BLUE SHIELD OF NORTH CAROLINA