Provider Demographics
NPI:1619757127
Name:BRANSCUM, STEPHANIE ROBERTSON (LCSWA)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:ROBERTSON
Last Name:BRANSCUM
Suffix:
Gender:F
Credentials:LCSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:265 MARINNA JOY CIR
Mailing Address - Street 2:
Mailing Address - City:ROCKWELL
Mailing Address - State:NC
Mailing Address - Zip Code:28138-8926
Mailing Address - Country:US
Mailing Address - Phone:704-953-6020
Mailing Address - Fax:
Practice Address - Street 1:2220 THE PLZ
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28205-3036
Practice Address - Country:US
Practice Address - Phone:704-953-6020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-02
Last Update Date:2023-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0165601041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical