Provider Demographics
NPI:1790327278
Name:L.C. BRAXTON COUNSELING, PLLC
Entity Type:Organization
Organization Name:L.C. BRAXTON COUNSELING, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/LICENSED PROFESSIONAL COUNSEL
Authorized Official - Prefix:DR
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:CAMILLE
Authorized Official - Last Name:BRAXTON
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:919-961-0334
Mailing Address - Street 1:5700 SIX FORKS RD STE 202
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27609-8616
Mailing Address - Country:US
Mailing Address - Phone:919-961-0334
Mailing Address - Fax:919-882-1553
Practice Address - Street 1:5700 SIX FORKS RD STE 202
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-8616
Practice Address - Country:US
Practice Address - Phone:919-961-0334
Practice Address - Fax:919-882-1553
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-16
Last Update Date:2019-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1053606848Medicaid