Healthcare Provider Details

I. General information

NPI: 1154154466
Provider Name (Legal Business Name): BRANDI HAMILTON ANTHONY LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/22/2024
Last Update Date: 08/22/2024
Certification Date: 08/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1450 FERN CREEK DR
STATESVILLE NC
28625-9376
US

IV. Provider business mailing address

200 E 2ND AVE
GASTONIA NC
28052-4358
US

V. Phone/Fax

Practice location:
  • Phone: 704-818-9191
  • Fax: 704-872-3782
Mailing address:
  • Phone: 704-874-1904
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC011358
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: