Provider Demographics
NPI:1548486897
Name:GRANOFF, BRANDI EDEN
Entity type:Individual
Prefix:
First Name:BRANDI
Middle Name:EDEN
Last Name:GRANOFF
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:PO BOX 573
Mailing Address - Street 2:
Mailing Address - City:LINVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28646-0573
Mailing Address - Country:US
Mailing Address - Phone:865-924-5267
Mailing Address - Fax:
Practice Address - Street 1:895 STATE FARM RD
Practice Address - Street 2:SUITE 503
Practice Address - City:BOONE
Practice Address - State:NC
Practice Address - Zip Code:28607-4917
Practice Address - Country:US
Practice Address - Phone:423-522-2200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-17
Last Update Date:2013-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health