Healthcare Provider Details

I. General information

NPI: 1336061050
Provider Name (Legal Business Name): ASHLEY BROOKE BRANCH LCMHCA
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2026
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 HIGHWOODS BLVD STE 310
RALEIGH NC
27604-1029
US

IV. Provider business mailing address

1277 BUFFALO RD UNIT B
SMITHFIELD NC
27577-7443
US

V. Phone/Fax

Practice location:
  • Phone: 912-549-2052
  • Fax:
Mailing address:
  • Phone: 912-549-2052
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberA21820
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: