Healthcare Provider Details

I. General information

NPI: 1528239167
Provider Name (Legal Business Name): BLANCA IVONNE BRANA LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/21/2008
Last Update Date: 07/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11249 LOCKWOOD DR STE C
SILVER SPRING MD
20901-4564
US

IV. Provider business mailing address

5470 HARPERS FARM RD APT A3
COLUMBIA MD
21044-1233
US

V. Phone/Fax

Practice location:
  • Phone: 301-323-5367
  • Fax:
Mailing address:
  • Phone: 301-323-5367
  • Fax: 877-200-5447

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLC3735
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: