Provider Demographics
NPI:1447368188
Name:BRANON, NATASHA RENA' (LPC)
Entity type:Individual
Prefix:MS
First Name:NATASHA
Middle Name:RENA'
Last Name:BRANON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:402 NAUTIQUE CIR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29229-7334
Mailing Address - Country:US
Mailing Address - Phone:803-546-0313
Mailing Address - Fax:
Practice Address - Street 1:16101 WRIGHT'S FERRY RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28278-7519
Practice Address - Country:US
Practice Address - Phone:803-546-0313
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2022-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4993101YP2500X
NC7303101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6104289Medicaid
SC421504Medicaid
SC421504Medicaid