Provider Demographics
NPI:1376747402
Name:BRASWELL, GEORGE ROBERT (MA, LPA)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:ROBERT
Last Name:BRASWELL
Suffix:
Gender:M
Credentials:MA, LPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:421 FLAT ROCK RD
Mailing Address - Street 2:
Mailing Address - City:HENRICO
Mailing Address - State:NC
Mailing Address - Zip Code:27842-9419
Mailing Address - Country:US
Mailing Address - Phone:252-532-5717
Mailing Address - Fax:
Practice Address - Street 1:421 FLAT ROCK RD
Practice Address - Street 2:
Practice Address - City:HENRICO
Practice Address - State:NC
Practice Address - Zip Code:27842-9419
Practice Address - Country:US
Practice Address - Phone:252-532-5717
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-13
Last Update Date:2010-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1402101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health