Provider Demographics
NPI:1235600057
Name:BRAILSFORD DE LOPEZ, ALAN ROBERT (LCSW LCAS CSI)
Entity Type:Individual
Prefix:
First Name:ALAN
Middle Name:ROBERT
Last Name:BRAILSFORD DE LOPEZ
Suffix:
Gender:M
Credentials:LCSW LCAS CSI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 N FRONT ST STE 704
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28401-5090
Mailing Address - Country:US
Mailing Address - Phone:910-769-9126
Mailing Address - Fax:910-769-9169
Practice Address - Street 1:201 N FRONT ST STE 704
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28401-5090
Practice Address - Country:US
Practice Address - Phone:910-769-9126
Practice Address - Fax:910-769-9169
Is Sole Proprietor?:No
Enumeration Date:2018-12-06
Last Update Date:2021-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCLCAS-23672101YA0400X
NCC0121661041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)