Provider Demographics
NPI:1467047035
Name:BROWNELL, RAISA A (LCSW)
Entity Type:Individual
Prefix:
First Name:RAISA
Middle Name:A
Last Name:BROWNELL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:RAISA
Other - Middle Name:ALISIA
Other - Last Name:MATHIES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:1005 N GLEBE RD STE 525
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22201-5792
Mailing Address - Country:US
Mailing Address - Phone:804-207-6737
Mailing Address - Fax:571-303-0708
Practice Address - Street 1:1005 N GLEBE RD STE 525
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22201-5792
Practice Address - Country:US
Practice Address - Phone:804-207-6737
Practice Address - Fax:571-303-0708
Is Sole Proprietor?:No
Enumeration Date:2021-03-05
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0147951041C0700X
VA09040145141041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA30017639560001Medicaid