Provider Demographics
NPI:1518535426
Name:BRANNON, TRACEY S (LISW-CP)
Entity Type:Individual
Prefix:MRS
First Name:TRACEY
Middle Name:S
Last Name:BRANNON
Suffix:
Gender:F
Credentials:LISW-CP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:129 NURSERY DR
Mailing Address - Street 2:
Mailing Address - City:ROEBUCK
Mailing Address - State:SC
Mailing Address - Zip Code:29376-2725
Mailing Address - Country:US
Mailing Address - Phone:864-621-0955
Mailing Address - Fax:
Practice Address - Street 1:129 NURSERY DR
Practice Address - Street 2:
Practice Address - City:ROEBUCK
Practice Address - State:SC
Practice Address - Zip Code:29376-2725
Practice Address - Country:US
Practice Address - Phone:864-621-0955
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-16
Last Update Date:2021-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC63181041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical