Healthcare Provider Details

I. General information

NPI: 1104982883
Provider Name (Legal Business Name): TABATHA RAE BRAFFORD LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/28/2006
Last Update Date: 09/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

91 TIMBERLANE RD
WAYNESVILLE NC
28786-7927
US

IV. Provider business mailing address

PO BOX 444
MURPHY NC
28906-0444
US

V. Phone/Fax

Practice location:
  • Phone: 828-452-1395
  • Fax: 828-452-1396
Mailing address:
  • Phone: 828-837-0071
  • Fax: 828-837-5309

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number4109
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: