MEDICARE: BRANDY HARRELL LCAS

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	1041C0700X	Clinical Social Worker	C018099	NC
2	101YA0400X	Addiction (Substance Use Disorder) Counselor	1918	NC

General Provider Information

NPI Number	:	1578849857
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRANDY HARRELL LCAS

Provider Business Mailing Address
First Line	:	324 N QUEEN ST
Second Line	:
City	:	KINSTON
State	:	NC
Zip	:	28501-4932
Country	:	US
Telephone Number	:	252-522-9800
Fax Number	:	252-525-4573

Provider Business Practice Location Address
First Line	:	107 S QUEEN ST
Second Line	:
City	:	KINSTON
State	:	NC
Zip	:	28501-4933
Country	:	US
Telephone Number	:	252-522-9800
Fax Number	:	252-523-9790

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

Provider Enumeration Date	:	10/31/2011
Last Update Date	:	02/05/2026

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