Provider Demographics
NPI:1881310787
Name:BRADY, COLIN HUGH (LPC)
Entity type:Individual
Prefix:
First Name:COLIN
Middle Name:HUGH
Last Name:BRADY
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 1:5300 ELSTON LN
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23455-6892
Mailing Address - Country:US
Mailing Address - Phone:757-305-6665
Mailing Address - Fax:
Practice Address - Street 1:3143 MAGIC HOLLOW BLVD STE 100
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23453-3077
Practice Address - Country:US
Practice Address - Phone:757-567-2868
Practice Address - Fax:757-368-3439
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-13
Last Update Date:2022-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701011782101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0701011782OtherLICENSED PROFESSIONAL COUNSELOR VA BOARD OF COUNSELING