Provider Demographics
NPI:1952723975
Name:WARSTLER, BRANDON CHARLES (LPCA, CRC, LCAS)
Entity Type:Individual
Prefix:
First Name:BRANDON
Middle Name:CHARLES
Last Name:WARSTLER
Suffix:
Gender:M
Credentials:LPCA, CRC, LCAS
Other - Prefix:
Other - First Name:CHARLIE
Other - Middle Name:
Other - Last Name:WARSTLER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:1139 HARP ST
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27604-1303
Mailing Address - Country:US
Mailing Address - Phone:828-712-6624
Mailing Address - Fax:
Practice Address - Street 1:1139 HARP ST
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27604-1303
Practice Address - Country:US
Practice Address - Phone:828-712-6624
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-09
Last Update Date:2014-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA10635101YP2500X
NC00117577225C00000X
NC20665101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No225C00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Counselor