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General NPI Number Information
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NPI Number | 1790260305
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Entity Type | Organization
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Legal Business Name | BRANCHES OF LIFE, LLC.
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Dates
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Enumeration Date | 09/28/2018
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Last Update Date | 09/28/2018
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Provider Practice Location Address
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Address Line | 3701 OLD COURT RD STE 17B
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City | PIKESVILLE
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State | MD
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Zip | 21208-3901
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Country | US
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Telephone | 443-929-9937
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Fax |
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Provider Business Mailing Address
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Address Line | 3701 OLD COURT RD STE 17B
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City | PIKESVILLE
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State | MD
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Zip | 21208-3901
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER/FOUNDER
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Name | MRS. DANIELLE BRANCHE
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Credential | LCMFT
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Telephone | 443-929-9937
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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