MEDICARE: DR. LAMAR WAUL-BRANSON LCPC

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	LC15936	MD

General Provider Information

NPI Number	:	1407641947
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LAMAR WAUL-BRANSON LCPC

Provider Business Mailing Address
First Line	:	22411 ROYAL OAK RD
Second Line	:
City	:	QUANTICO
State	:	MD
Zip	:	21856-2087
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	22411 ROYAL OAK RD
Second Line	:
City	:	QUANTICO
State	:	MD
Zip	:	21856-2087
Country	:	US
Telephone Number	:	443-653-0290
Fax Number	:

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

Provider Enumeration Date	:	04/14/2025
Last Update Date	:	04/14/2025

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