MEDICARE: RUBY BRAKE

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	101YM0800X	Mental Health Counselor	A20516	NC

General Provider Information

NPI Number	:	1023836319
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RUBY BRAKE

Provider Business Mailing Address
First Line	:	3469 BORUM DR
Second Line	:
City	:	WINSTON SALEM
State	:	NC
Zip	:	27107-4501
Country	:	US
Telephone Number	:	704-441-3230
Fax Number	:

Provider Business Practice Location Address
First Line	:	3469 BORUM DR
Second Line	:
City	:	WINSTON SALEM
State	:	NC
Zip	:	27107-4501
Country	:	US
Telephone Number	:	704-441-3230
Fax Number	:

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

Provider Enumeration Date	:	09/26/2024
Last Update Date	:	09/26/2024

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Directions to “ RUBY BRAKE ” Practice Location

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