Provider Demographics
NPI:1740912898
Name:BRANSON, CONNOR (MSW, LCSWA)
Entity type:Individual
Prefix:
First Name:CONNOR
Middle Name:
Last Name:BRANSON
Suffix:
Gender:M
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 1:1019 E BOYD ST
Mailing Address - Street 2:
Mailing Address - City:MAIDEN
Mailing Address - State:NC
Mailing Address - Zip Code:28650-1725
Mailing Address - Country:US
Mailing Address - Phone:608-843-9062
Mailing Address - Fax:
Practice Address - Street 1:125 N TRADD ST
Practice Address - Street 2:
Practice Address - City:STATESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28677-5280
Practice Address - Country:US
Practice Address - Phone:704-201-9063
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-28
Last Update Date:2022-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0177071041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1060Medicaid