Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YA0400X | Addiction Counselor (Substance Use Disorder) | 23683 | NC |
Y | 101YM0800X | Mental Health Counselor | 13179 | NC |
N | 225C00000X | Rehabilitation Counselor | 00188145 | NC |
NPI | 1194239665 |
---|---|
Provider Name | Mr. Brandon Andre Jevon James |
First Address | Greensboro, NC 27407 |
Second Address | Winston Salem, NC 27107-1361 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/11/2017 |
Last Update Date | 17/03/2021 |