Healthcare Provider Details

I. General information

NPI: 1083254270
Provider Name (Legal Business Name): BRANDY RAE CARLTON LCMHC, LCAS-A
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/15/2020
Last Update Date: 10/16/2022
Certification Date: 10/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

135 MACARTHUR ST
ASHEBORO NC
27203-5410
US

IV. Provider business mailing address

135 MACARTHUR ST
ASHEBORO NC
27203-5410
US

V. Phone/Fax

Practice location:
  • Phone: 366-689-9723
  • Fax: 855-941-6011
Mailing address:
  • Phone: 366-689-9723
  • Fax: 855-941-6011

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLCAS-26186
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number15498
License Number StateNC
# 3
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number15498
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: