NPIMap

Organization Active NPI

Embrenche LLC

  • Psychologist
  • Winston Salem, NC
National Provider Identifier
1295870194
Registry record updated Sep 11, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
Legal business name
EMBRENCHE LLC
Doing business as
embrenche
Practice address
1001 S Marshall St Ste 262
1001 S Marshall Street Suite 262
Winston Salem, NC 27101-5852
Phone
(336) 722-8055
Fax
(336) 722-4161
NPI assigned
Feb 20, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 11, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Marty Hickman
Title
Director
Phone
(336) 624-9618

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103T00000X Primary
Clinical Social WorkerGroup: 193200000X MULTI-SPECIALTY GROUP 1041C0700X
Psychiatry PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2084P0800X
Child & Adolescent Psychiatry PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2084P0804X

Addresses

Primary practice location

1001 S Marshall St Ste 262
1001 S Marshall Street Suite 262
Winston Salem, NC 27101-5852

Mailing address

1001 S Marshall St Ste 262
1001 S Marshall Street Suite 262
Winston Salem, NC 27101-5852
Phone (336) 722-8055

Other identifiers 1

IdentifierTypeStateIssuer
6005992MedicaidNC

Other names 1

  • embrenche Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Embrenche5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the National Provider Directory.

Locations

1001 S Marshall St
Ste 262
Winston Salem, NC 27101
Phone (336) 722-8055

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1171929600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1757548800000",
    "number": "1295870194",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1001 S MARSHALL ST STE 262",
            "address_2": "1001 S MARSHALL STREET SUITE 262",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271015852",
            "telephone_number": "336-722-8055",
            "fax_number": "336-722-4161"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1001 S MARSHALL ST STE 262",
            "address_2": "1001 S MARSHALL STREET SUITE 262",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271015852",
            "telephone_number": "336-722-8055",
            "fax_number": "336-722-4161"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EMBRENCHE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-20",
        "last_updated": "2025-09-11",
        "status": "A",
        "authorized_official_last_name": "HICKMAN",
        "authorized_official_first_name": "MARTY",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "336-624-9618"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2084P0804X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6005992",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "embrenche",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Winston Salem, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.