Provider Demographics
NPI:1346017118
Name:BRANSCOMB COUNSELING PLLC
Entity Type:Organization
Organization Name:BRANSCOMB COUNSELING PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORGANIZER
Authorized Official - Prefix:
Authorized Official - First Name:JOEL
Authorized Official - Middle Name:
Authorized Official - Last Name:BRANSCOMB
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-413-6717
Mailing Address - Street 1:5325 FAIRBURN DR
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27106-6312
Mailing Address - Country:US
Mailing Address - Phone:336-413-6717
Mailing Address - Fax:
Practice Address - Street 1:4555 SHATTALON DR
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27106-2052
Practice Address - Country:US
Practice Address - Phone:336-413-6717
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-11
Last Update Date:2023-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)