Healthcare Provider Details

I. General information

NPI: 1851188783
Provider Name (Legal Business Name): BREANNA WORTHEY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/23/2025
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 N MAIN ST STE 1202
WINSTON SALEM NC
27101-3819
US

IV. Provider business mailing address

5106 MICHAUX RD UNIT 204
GREENSBORO NC
27410-9917
US

V. Phone/Fax

Practice location:
  • Phone: 336-721-4262
  • Fax:
Mailing address:
  • Phone: 732-515-0769
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: