Healthcare Provider Details

I. General information

NPI: 1659684330
Provider Name (Legal Business Name): LISA BRANHAM EDS., LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/22/2010
Last Update Date: 03/11/2026
Certification Date: 03/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

203 W MAIN ST STE C3
LEXINGTON SC
29072-2670
US

IV. Provider business mailing address

203 W MAIN ST STE C3
LEXINGTON SC
29072-2670
US

V. Phone/Fax

Practice location:
  • Phone: 803-772-7776
  • Fax: 844-440-2320
Mailing address:
  • Phone: 803-772-7776
  • Fax: 844-440-2320

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number5022
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: