Provider Demographics
NPI:1083743660
Name:KOHR, BRANDI M (MSSA)
Entity Type:Individual
Prefix:MS
First Name:BRANDI
Middle Name:M
Last Name:KOHR
Suffix:
Gender:F
Credentials:MSSA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7038 LANDINGHAM DR
Mailing Address - Street 2:
Mailing Address - City:WILLOW SPRING
Mailing Address - State:NC
Mailing Address - Zip Code:27592-8620
Mailing Address - Country:US
Mailing Address - Phone:919-601-9222
Mailing Address - Fax:919-552-9918
Practice Address - Street 1:374 RALEIGH STREET
Practice Address - Street 2:
Practice Address - City:HOLLY SPRING
Practice Address - State:NC
Practice Address - Zip Code:27540-0000
Practice Address - Country:US
Practice Address - Phone:919-601-9222
Practice Address - Fax:919-552-9918
Is Sole Proprietor?:No
Enumeration Date:2007-03-02
Last Update Date:2011-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI 10700314-SUPV1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
9377451OtherMEDICARE PTAN