Healthcare Provider Details

I. General information

NPI: 1588220354
Provider Name (Legal Business Name): JASON TIMOTHY BRANCH LCSWA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/16/2019
Last Update Date: 10/10/2025
Certification Date: 10/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2106 HOPE MILLS RD
FAYETTEVILLE NC
28304-4226
US

IV. Provider business mailing address

2106 HOPE MILLS RD
FAYETTEVILLE NC
28304-4226
US

V. Phone/Fax

Practice location:
  • Phone: 910-860-7008
  • Fax: 910-221-9006
Mailing address:
  • Phone: 910-860-7008
  • Fax: 910-221-9006

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC015261
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: