Healthcare Provider Details

I. General information

NPI: 1629162755
Provider Name (Legal Business Name): CARRIE BRAVINDER LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 06/01/2022
Certification Date: 06/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12 FLATFORD RD
STAFFORD VA
22554-3949
US

IV. Provider business mailing address

24 WHITE CHAPEL LN
STAFFORD VA
22554-8593
US

V. Phone/Fax

Practice location:
  • Phone: 800-305-2089
  • Fax:
Mailing address:
  • Phone: 321-795-8596
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPC 00162
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number14768
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberMH 10728
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number4789
License Number StateOK
# 5
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number74487
License Number StateTX
# 6
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0184121
License Number StateNM
# 7
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0701011497
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: