=====================================================
General NPI Number Information
=====================================================
NPI Number | 1679172019
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BRAVE WITHIN COUNSELING LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/17/2020
-----------------------------------------------------
Last Update Date | 04/19/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 11815 FOUNTAIN WAY STE 300
-----------------------------------------------------
City | NEWPORT NEWS
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23606-4448
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 844-502-7283
-----------------------------------------------------
Fax | 757-517-0612
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 969 LACON DR
-----------------------------------------------------
City | NEWPORT NEWS
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23608-2526
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 757-746-4357
-----------------------------------------------------
Fax | 757-517-0612
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | FOUNDER, OWNER
-----------------------------------------------------
Name | HYON J. BACHMAN
-----------------------------------------------------
Credential | LPC
-----------------------------------------------------
Telephone | 757-746-4357
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------