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General NPI Number Information
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NPI Number | 1063244515
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Entity Type | Individual
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Provider Name | BRENNAN LYNN DAGENHART CADC-R
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Gender | Male
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Dates
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Enumeration Date | 08/14/2024
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Last Update Date | 10/08/2024
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Provider Practice Location Address
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Address Line | 45 OPTICAL CT NW
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City | CONCORD
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State | NC
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Zip | 28025-0061
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Country | US
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Telephone | 980-270-5500
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Fax |
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Provider Business Mailing Address
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Address Line | 240 HENNING DR
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City | ALBEMARLE
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State | NC
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Zip | 28001-9772
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Country | US
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Telephone | 336-422-2541
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 30157
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 30157
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License Number State | NC
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