Provider Demographics
NPI:1871957852
Name:DYER, BRANDON (MA, LPC)
Entity type:Individual
Prefix:
First Name:BRANDON
Middle Name:
Last Name:DYER
Suffix:
Gender:M
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1606 NEW BERN ST
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:NC
Mailing Address - Zip Code:28570-9634
Mailing Address - Country:US
Mailing Address - Phone:336-554-1446
Mailing Address - Fax:
Practice Address - Street 1:1606 NEW BERN ST
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:NC
Practice Address - Zip Code:28570-9634
Practice Address - Country:US
Practice Address - Phone:336-554-1446
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-06
Last Update Date:2017-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA10940101YP2500X
NC10940101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional