Provider Demographics
NPI:1922989441
Name:ABLE, BRANDON RAY (NCCPSS)
Entity type:Individual
Prefix:
First Name:BRANDON
Middle Name:RAY
Last Name:ABLE
Suffix:
Gender:M
Credentials:NCCPSS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:206 FIFTH ST
Mailing Address - Street 2:
Mailing Address - City:MAYSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28555-8043
Mailing Address - Country:US
Mailing Address - Phone:910-467-6565
Mailing Address - Fax:
Practice Address - Street 1:206 FIFTH ST
Practice Address - Street 2:
Practice Address - City:MAYSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28555-8043
Practice Address - Country:US
Practice Address - Phone:910-467-6565
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-10
Last Update Date:2025-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2024-11326-01175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist