Provider Demographics
NPI:1104107267
Name:BRANNON, DREW R (PHD)
Entity type:Individual
Prefix:DR
First Name:DREW
Middle Name:R
Last Name:BRANNON
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:86 VILLA RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29615-3052
Mailing Address - Country:US
Mailing Address - Phone:864-239-4110
Mailing Address - Fax:864-242-9808
Practice Address - Street 1:86 VILLA RD
Practice Address - Street 2:SUITE B
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29615-3052
Practice Address - Country:US
Practice Address - Phone:864-239-4110
Practice Address - Fax:864-242-9808
Is Sole Proprietor?:No
Enumeration Date:2011-09-02
Last Update Date:2011-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1194103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist