MEDICARE: BREANNA JULEEN KING

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	A22233	NC

General Provider Information

NPI Number	:	1013879931
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BREANNA JULEEN KING

Provider Business Mailing Address
First Line	:	5121 BENTGRASS RUN DR
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28269-6129
Country	:	US
Telephone Number	:	704-999-9488
Fax Number	:

Provider Business Practice Location Address
First Line	:	5121 BENTGRASS RUN DR
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28269-6129
Country	:	US
Telephone Number	:	704-999-9488
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/01/2025
Last Update Date	:	12/01/2025

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Directions to “ BREANNA JULEEN KING ” Practice Location

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