Healthcare Provider Details

I. General information

NPI: 1679498026
Provider Name (Legal Business Name): SUE BRANON STEPHENS LCMHC-A
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/13/2026
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3809 PEACHTREE AVE STE 210
WILMINGTON NC
28403-6731
US

IV. Provider business mailing address

3809 PEACHTREE AVE STE 210
WILMINGTON NC
28403-6731
US

V. Phone/Fax

Practice location:
  • Phone: 910-251-7789
  • Fax: 910-399-6598
Mailing address:
  • Phone: 910-251-7789
  • Fax: 910-399-6598

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberAA23320
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: