Healthcare Provider Details

I. General information

NPI: 1720922743
Provider Name (Legal Business Name): PATRICIA ANN BRANTLEY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/18/2026
Last Update Date: 04/18/2026
Certification Date: 04/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6406 OGLETHORPE MILL DR
BRANDYWINE MD
20613-5690
US

IV. Provider business mailing address

6406 OGLETHORPE MILL DR
BRANDYWINE MD
20613-5690
US

V. Phone/Fax

Practice location:
  • Phone: 301-741-9660
  • Fax:
Mailing address:
  • Phone: 301-741-9660
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPRC1275
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: