Provider Demographics
NPI:1588408512
Name:BRANTON, MICHAEL LEE (LCMHC-A)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:LEE
Last Name:BRANTON
Suffix:
Gender:M
Credentials:LCMHC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 KIMEL FOREST DR
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-6074
Mailing Address - Country:US
Mailing Address - Phone:336-716-9034
Mailing Address - Fax:
Practice Address - Street 1:403 S HAWTHORNE RD
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-3784
Practice Address - Country:US
Practice Address - Phone:336-716-0855
Practice Address - Fax:336-716-0822
Is Sole Proprietor?:No
Enumeration Date:2024-06-24
Last Update Date:2024-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA20038101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional