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General NPI Number Information
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NPI Number | 1245747211
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Entity Type | Individual
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Provider Name | BRIAN MANN MA, LPC
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Gender | Male
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Dates
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Enumeration Date | 12/29/2017
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Last Update Date | 12/29/2017
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Provider Practice Location Address
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Address Line | 3722 BENSON DR STE 101
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City | RALEIGH
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State | NC
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Zip | 27609-7389
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Country | US
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Telephone | 919-448-6105
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Fax |
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Provider Business Mailing Address
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Address Line | 4116 ALPINE CLOVER DR
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City | WAKE FOREST
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State | NC
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Zip | 27587-3959
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Country | US
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Telephone | 919-435-7127
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 12217
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License Number State | NC
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