Provider Demographics
NPI:1194239665
Name:JAMES, BRANDON ANDRE JEVON (LCMHC,LCAS-A, CRC)
Entity type:Individual
Prefix:MR
First Name:BRANDON
Middle Name:ANDRE JEVON
Last Name:JAMES
Suffix:
Gender:M
Credentials:LCMHC,LCAS-A, CRC
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Mailing Address - Street 1:4626 WEST MARKET STREET SUITE C PO BOX 229
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27407
Mailing Address - Country:US
Mailing Address - Phone:336-814-6524
Mailing Address - Fax:336-355-9619
Practice Address - Street 1:1922 S MARTIN LUTHER KING JR DR STE 225
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27107-1361
Practice Address - Country:US
Practice Address - Phone:336-464-3136
Practice Address - Fax:336-734-6917
Is Sole Proprietor?:No
Enumeration Date:2017-11-20
Last Update Date:2021-03-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC23683101YA0400X
NC00188145225C00000X
NC13179101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No225C00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Counselor