Healthcare Provider Details

I. General information

NPI: 1447368188
Provider Name (Legal Business Name): NATASHA RENA' BRANON LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2006
Last Update Date: 11/20/2022
Certification Date: 11/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16101 WRIGHT'S FERRY RD
CHARLOTTE NC
28278-7519
US

IV. Provider business mailing address

402 NAUTIQUE CIR
COLUMBIA SC
29229-7334
US

V. Phone/Fax

Practice location:
  • Phone: 803-546-0313
  • Fax:
Mailing address:
  • Phone: 803-546-0313
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number4993
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number7303
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: