Provider Demographics
NPI:1407352016
Name:SPARROW, BREANNA ELDER (LCMHC)
Entity Type:Individual
Prefix:MRS
First Name:BREANNA
Middle Name:ELDER
Last Name:SPARROW
Suffix:
Gender:F
Credentials:LCMHC
Other - Prefix:MISS
Other - First Name:BREANNA
Other - Middle Name:CATHLEEN
Other - Last Name:SPARROW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:259 AZALEA DR
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27105-1789
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2499 HENNING DR
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27106-4558
Practice Address - Country:US
Practice Address - Phone:336-291-7477
Practice Address - Fax:336-217-8044
Is Sole Proprietor?:No
Enumeration Date:2018-04-03
Last Update Date:2022-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA13770101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional