Healthcare Provider Details

I. General information

NPI: 1679401699
Provider Name (Legal Business Name): THE BEARDED LCSW, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2026
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3140 CHAPARRAL DR BUILDING C STE 109
ROANOKE VA
24018-4370
US

IV. Provider business mailing address

2622 KENNEDY ST NE
ROANOKE VA
24012-4440
US

V. Phone/Fax

Practice location:
  • Phone: 540-998-6207
  • Fax:
Mailing address:
  • Phone: 540-998-6207
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: BRANDON MCGHEE
Title or Position: OWNER
Credential: LCSW
Phone: 540-998-6207