Provider Demographics
NPI:1619213030
Name:ST JOHN, BRANDY (LPC)
Entity Type:Individual
Prefix:
First Name:BRANDY
Middle Name:
Last Name:ST JOHN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1478
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:23927-1478
Mailing Address - Country:US
Mailing Address - Phone:434-572-6916
Mailing Address - Fax:434-374-3321
Practice Address - Street 1:424 HAMILTON BLVD
Practice Address - Street 2:
Practice Address - City:SOUTH BOSTON
Practice Address - State:VA
Practice Address - Zip Code:24592-5200
Practice Address - Country:US
Practice Address - Phone:434-572-4863
Practice Address - Fax:434-572-4978
Is Sole Proprietor?:No
Enumeration Date:2012-12-13
Last Update Date:2016-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701006492101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional