Provider Demographics
NPI:1740367267
Name:MEHAFFEY, BRANDY FRANKLIN (LICENSED PROFESSIONA)
Entity type:Individual
Prefix:
First Name:BRANDY
Middle Name:FRANKLIN
Last Name:MEHAFFEY
Suffix:
Gender:F
Credentials:LICENSED PROFESSIONA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:POST OFFICE BOX 1033
Mailing Address - Street 2:
Mailing Address - City:WARRENTON
Mailing Address - State:VA
Mailing Address - Zip Code:20188-1033
Mailing Address - Country:US
Mailing Address - Phone:540-341-1033
Mailing Address - Fax:866-820-9407
Practice Address - Street 1:17 S FIFTH ST
Practice Address - Street 2:SUITE A
Practice Address - City:WARRENTON
Practice Address - State:VA
Practice Address - Zip Code:20186-3369
Practice Address - Country:US
Practice Address - Phone:540-341-1033
Practice Address - Fax:866-820-9407
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2012-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701003575101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA004945247Medicaid
VA004978277Medicaid
VA210245OtherBLUE CROSS BLUE SHIELD
VA365184OtherANTHEM
VA365184OtherANTHEM