Provider Demographics
NPI:1205018835
Name:BRANSCUM, LARRY VAN (LPC)
Entity Type:Individual
Prefix:MR
First Name:LARRY
Middle Name:VAN
Last Name:BRANSCUM
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:MR
Other - First Name:LAWRNECE
Other - Middle Name:VAN
Other - Last Name:BRANSCUM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPC
Mailing Address - Street 1:129 BEN MAR LN
Mailing Address - Street 2:
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28791-8413
Mailing Address - Country:US
Mailing Address - Phone:828-890-3008
Mailing Address - Fax:828-890-3031
Practice Address - Street 1:129 BEN MAR LN
Practice Address - Street 2:
Practice Address - City:HENDERSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28791-8413
Practice Address - Country:US
Practice Address - Phone:828-890-3008
Practice Address - Fax:828-890-3031
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-05
Last Update Date:2010-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6539101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health