Provider Demographics
NPI:1568840130
Name:LINCOLN, BRANDIE NATASHA
Entity type:Individual
Prefix:
First Name:BRANDIE
Middle Name:NATASHA
Last Name:LINCOLN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1802 N. CARSON STREET, SUITE 103
Mailing Address - Street 2:
Mailing Address - City:CARSON CITY
Mailing Address - State:NV
Mailing Address - Zip Code:89701-1012
Mailing Address - Country:US
Mailing Address - Phone:775-350-4809
Mailing Address - Fax:
Practice Address - Street 1:1802 N. CARSON STREET, SUITE 103
Practice Address - Street 2:
Practice Address - City:CARSON CITY
Practice Address - State:NV
Practice Address - Zip Code:89701-8970
Practice Address - Country:US
Practice Address - Phone:775-350-4809
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-14
Last Update Date:2024-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV00826-C101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)