Provider Demographics
NPI:1669115986
Name:BRANCH, KEIRO YAHNEY (LCSWA)
Entity type:Individual
Prefix:
First Name:KEIRO
Middle Name:YAHNEY
Last Name:BRANCH
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 1:220 E BOULDER RD
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NC
Mailing Address - Zip Code:27537-6982
Mailing Address - Country:US
Mailing Address - Phone:984-365-3532
Mailing Address - Fax:
Practice Address - Street 1:2231 E MILLBROOK RD STE 101
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27604-1746
Practice Address - Country:US
Practice Address - Phone:919-307-8165
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-14
Last Update Date:2022-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0174211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty