Provider Demographics
NPI:1629162755
Name:BRAVINDER, CARRIE (LPC)
Entity Type:Individual
Prefix:MS
First Name:CARRIE
Middle Name:
Last Name:BRAVINDER
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 1:24 WHITE CHAPEL LN
Mailing Address - Street 2:
Mailing Address - City:STAFFORD
Mailing Address - State:VA
Mailing Address - Zip Code:22554-8593
Mailing Address - Country:US
Mailing Address - Phone:321-795-8596
Mailing Address - Fax:
Practice Address - Street 1:12 FLATFORD RD
Practice Address - Street 2:
Practice Address - City:STAFFORD
Practice Address - State:VA
Practice Address - Zip Code:22554-3949
Practice Address - Country:US
Practice Address - Phone:800-305-2089
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2022-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLPC 00162101YM0800X
NC14768101YM0800X
FLMH 10728101YP2500X
OK4789101YP2500X
TX74487101YP2500X
NM0184121101YP2500X
VA0701011497101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health