Provider Demographics
NPI:1063951622
Name:TOLLEY, BRANDON (LPC)
Entity type:Individual
Prefix:
First Name:BRANDON
Middle Name:
Last Name:TOLLEY
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 1:43130 AMBERWOOD PLZ STE 140
Mailing Address - Street 2:
Mailing Address - City:SOUTH RIDING
Mailing Address - State:VA
Mailing Address - Zip Code:20152-4107
Mailing Address - Country:US
Mailing Address - Phone:703-348-0030
Mailing Address - Fax:
Practice Address - Street 1:43130 AMBERWOOD PLZ STE 140
Practice Address - Street 2:
Practice Address - City:SOUTH RIDING
Practice Address - State:VA
Practice Address - Zip Code:20152-4107
Practice Address - Country:US
Practice Address - Phone:703-348-0030
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-15
Last Update Date:2020-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701006925101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional