Provider Demographics
NPI:1033819529
Name:BRAVO MENTAL WELLNESS PLLC
Entity Type:Organization
Organization Name:BRAVO MENTAL WELLNESS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PMHNP
Authorized Official - Prefix:
Authorized Official - First Name:SASHA
Authorized Official - Middle Name:
Authorized Official - Last Name:BRAVO
Authorized Official - Suffix:
Authorized Official - Credentials:MSN
Authorized Official - Phone:828-776-5155
Mailing Address - Street 1:921 E BROAD ST # 1065
Mailing Address - Street 2:
Mailing Address - City:FUQUAY VARINA
Mailing Address - State:NC
Mailing Address - Zip Code:27526-1960
Mailing Address - Country:US
Mailing Address - Phone:828-776-5155
Mailing Address - Fax:919-214-1327
Practice Address - Street 1:174 MINE LAKE CT STE 200
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27615-6417
Practice Address - Country:US
Practice Address - Phone:919-769-1910
Practice Address - Fax:919-214-5388
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-06
Last Update Date:2023-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5014097OtherNORTH CAROLINA BOARD OF NURSING NP LICENSE NUMBER