Individual
BRENDA L. PUCKETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
1123 S CHURCH ST, CHARLOTTE, NC 28203-4003
(704) 370-3235
(704) 370-3377
Mailing address
1123 S CHURCH ST, CHARLOTTE, NC 28203-4003
(704) 370-3235
(704) 370-3377
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
5337
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
143V1
BLUECROSS BLUESHIELD NC
NC
01
—
191999
MEDCOST
NC
Enumeration date
03/22/2007
Last updated
07/08/2007
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