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General NPI Number Information
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NPI Number | 1245929892
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Entity Type | Individual
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Provider Name | BRANDON LABARGE M.S., M.ED., LPC
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Gender | Male
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Dates
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Enumeration Date | 05/01/2023
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Last Update Date | 05/01/2023
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Provider Practice Location Address
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Address Line | 324 MONTICELLO AVE
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City | WILLIAMSBURG
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State | VA
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Zip | 23185-2834
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Country | US
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Telephone | 757-503-7917
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Fax | 855-823-3243
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Provider Business Mailing Address
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Address Line | 324 MONTICELLO AVE
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City | WILLIAMSBURG
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State | VA
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Zip | 23185-2834
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Country | US
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Telephone | 757-503-7917
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Fax | 855-823-3243
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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