Provider Demographics
NPI:1073937447
Name:LOWE, BRANDON (MS LPC LCAS CSOTP)
Entity Type:Individual
Prefix:
First Name:BRANDON
Middle Name:
Last Name:LOWE
Suffix:
Gender:M
Credentials:MS LPC LCAS CSOTP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:335 CREEKVIEW DR
Mailing Address - Street 2:
Mailing Address - City:KERNERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27284-6832
Mailing Address - Country:US
Mailing Address - Phone:336-509-3373
Mailing Address - Fax:
Practice Address - Street 1:1922 S MARTIN LUTHER KING JR DR STE 225
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27107-1361
Practice Address - Country:US
Practice Address - Phone:336-464-3136
Practice Address - Fax:336-734-6917
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-05
Last Update Date:2021-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCLCAS 20339101YA0400X
NCLPC 11263101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)