Healthcare Provider Details

I. General information

NPI: 1770097388
Provider Name (Legal Business Name): MICHELLE L. BRACHTEN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/20/2017
Last Update Date: 03/30/2026
Certification Date: 03/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1360 BEVERLY RD STE 200
MC LEAN VA
22101-3647
US

IV. Provider business mailing address

1360 BEVERLY RD STE 200
MC LEAN VA
22101-3647
US

V. Phone/Fax

Practice location:
  • Phone: 804-207-6737
  • Fax:
Mailing address:
  • Phone: 804-207-6737
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0904016887
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC014237
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberP012126
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: