Provider Demographics
NPI:1992395487
Name:MCCOY, BREANNAH R (MSW, LCSWA)
Entity Type:Individual
Prefix:
First Name:BREANNAH
Middle Name:R
Last Name:MCCOY
Suffix:
Gender:F
Credentials:MSW, LCSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:418 EUGENE CT
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27401-2714
Mailing Address - Country:US
Mailing Address - Phone:336-365-8354
Mailing Address - Fax:336-365-2380
Practice Address - Street 1:418 EUGENE CT
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27401-2714
Practice Address - Country:US
Practice Address - Phone:336-365-8354
Practice Address - Fax:336-365-2380
Is Sole Proprietor?:No
Enumeration Date:2021-01-19
Last Update Date:2021-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0137401041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical