Provider Demographics
NPI:1750138301
Name:HAMLIN, BRANDON SCOTT (LPC)
Entity type:Individual
Prefix:
First Name:BRANDON
Middle Name:SCOTT
Last Name:HAMLIN
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:707 GITTINGS ST STE 120
Mailing Address - Street 2:
Mailing Address - City:SUFFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23434-6101
Mailing Address - Country:US
Mailing Address - Phone:757-514-3248
Mailing Address - Fax:757-809-5387
Practice Address - Street 1:707 GITTINGS ST STE 120
Practice Address - Street 2:
Practice Address - City:SUFFOLK
Practice Address - State:VA
Practice Address - Zip Code:23434-6101
Practice Address - Country:US
Practice Address - Phone:757-514-3248
Practice Address - Fax:757-809-5387
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-02
Last Update Date:2024-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701013515101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1689042780Medicaid