Healthcare Provider Details

I. General information

NPI: 1578849857
Provider Name (Legal Business Name): BRANDY HARRELL LCAS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/31/2011
Last Update Date: 03/09/2026
Certification Date: 03/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

313 MAIN STREET
BAYBORO NC
28515-9529
US

IV. Provider business mailing address

7 PROFESSIONAL DR
SNOW HILL NC
28580-1332
US

V. Phone/Fax

Practice location:
  • Phone: 252-745-2070
  • Fax:
Mailing address:
  • Phone: 252-747-8162
  • Fax: 252-747-8163

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number1918
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC018099
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: