Provider Demographics
NPI:1578849857
Name:HARRELL, BRANDY (LCAS)
Entity Type:Individual
Prefix:
First Name:BRANDY
Middle Name:
Last Name:HARRELL
Suffix:
Gender:F
Credentials:LCAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:324 N QUEEN ST
Mailing Address - Street 2:
Mailing Address - City:KINSTON
Mailing Address - State:NC
Mailing Address - Zip Code:28501-4932
Mailing Address - Country:US
Mailing Address - Phone:252-522-9800
Mailing Address - Fax:252-525-4573
Practice Address - Street 1:107 S QUEEN ST
Practice Address - Street 2:
Practice Address - City:KINSTON
Practice Address - State:NC
Practice Address - Zip Code:28501-4933
Practice Address - Country:US
Practice Address - Phone:252-522-9800
Practice Address - Fax:252-523-9790
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-31
Last Update Date:2022-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1918101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)