MEDICARE: BRANDIE MICHELLE WESLEY LCMHC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	9350	NE
2	101YM0800X	Mental Health Counselor	4242	NE
3	101YM0800X	Mental Health Counselor	17307	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1134413024
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRANDIE MICHELLE WESLEY LCMHC

Provider Business Mailing Address
First Line	:	8801 FAST PARK DR STE 301
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27617-4853
Country	:	US
Telephone Number	:	919-589-2170
Fax Number	:

Provider Business Practice Location Address
First Line	:	8801 FAST PARK DR
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27617-4852
Country	:	US
Telephone Number	:	919-589-2170
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/08/2011
Last Update Date	:	03/30/2022

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