Healthcare Provider Details

I. General information

NPI: 1508421694
Provider Name (Legal Business Name): BREANNA USSERY LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2019
Last Update Date: 10/10/2024
Certification Date: 10/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

925 BRADLEY ST NE
CONCORD NC
28025-0911
US

IV. Provider business mailing address

3210 PROSPERITY CHURCH RD STE 101
CHARLOTTE NC
28269-8194
US

V. Phone/Fax

Practice location:
  • Phone: 704-360-3637
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC017351
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberP016424
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: