Provider Demographics
NPI:1417594631
Name:BRANTLEY, PHILLIP MICHAEL (MA, LCMHC, NCC)
Entity type:Individual
Prefix:
First Name:PHILLIP
Middle Name:MICHAEL
Last Name:BRANTLEY
Suffix:
Gender:M
Credentials:MA, LCMHC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:785 BEE TREE RD
Mailing Address - Street 2:
Mailing Address - City:SWANNANOA
Mailing Address - State:NC
Mailing Address - Zip Code:28778-3404
Mailing Address - Country:US
Mailing Address - Phone:252-425-7181
Mailing Address - Fax:
Practice Address - Street 1:802 FAIRVIEW RD STE 4000
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28803-1170
Practice Address - Country:US
Practice Address - Phone:828-367-7719
Practice Address - Fax:828-820-5503
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-06
Last Update Date:2024-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC14953101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional