Organization
EMBRENCHE LLC
Active
Other names
embrenche
Organization subpart
No
Provider details
NPI number
Authorized official
MARTY HICKMAN (DIRECTOR)
(336) 624-9618
Entity
Organization
Contact information
Practice address
1001 S MARSHALL ST STE 262, 1001 S MARSHALL STREET SUITE 262, WINSTON SALEM, NC 27101-5852
(336) 722-8055
(336) 722-4161
Mailing address
1001 S MARSHALL ST STE 262, 1001 S MARSHALL STREET SUITE 262, WINSTON SALEM, NC 27101-5852
(336) 722-8055
(336) 722-4161
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
—
—
1041C0700X
Clinical Social Worker
—
—
2084P0800X
Psychiatry Physician
—
—
2084P0804X
Child & Adolescent Psychiatry Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
6005992
—
NC
Enumeration date
02/20/2007
Last updated
09/11/2025
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