|Taxonomy Code||Specialty Code||Provider Type|
|1041C0700X||80||Licensed Clinical Social Worker|
|LBN Legal business name||PROFESSIONAL COUNSELING ASSOCIATES, LLC|
|Authorized official||RAYMOND BRANTON - (OWNER, PARTNER)|
|Organization subpart 1||Not specified|
|Last updated||07/08/2007 - About 9 years ago|
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