Provider Demographics
NPI:1447011382
Name:GRIFFIN, BRANDON WAYNE (LCMHC)
Entity type:Individual
Prefix:
First Name:BRANDON
Middle Name:WAYNE
Last Name:GRIFFIN
Suffix:
Gender:M
Credentials:LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:429 GRANITE CREEK DR
Mailing Address - Street 2:
Mailing Address - City:ROLESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27571-9712
Mailing Address - Country:US
Mailing Address - Phone:252-382-0662
Mailing Address - Fax:
Practice Address - Street 1:429 GRANITE CREEK DR
Practice Address - Street 2:
Practice Address - City:ROLESVILLE
Practice Address - State:NC
Practice Address - Zip Code:27571-9712
Practice Address - Country:US
Practice Address - Phone:252-382-0662
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-18
Last Update Date:2024-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA19590101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health