Provider Demographics
NPI:1992391866
Name:BRAVO, CAROLINE ANNE (LPC, MA)
Entity Type:Individual
Prefix:
First Name:CAROLINE
Middle Name:ANNE
Last Name:BRAVO
Suffix:
Gender:F
Credentials:LPC, MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1305 16TH AVE S
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37212-2923
Mailing Address - Country:US
Mailing Address - Phone:615-434-5779
Mailing Address - Fax:
Practice Address - Street 1:1305 16TH AVE S
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37212-2923
Practice Address - Country:US
Practice Address - Phone:615-434-5779
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-15
Last Update Date:2020-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4324101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor