Provider Demographics
NPI:1063989473
Name:CARLTON, BRANDIE MARIE (LCSW)
Entity type:Individual
Prefix:
First Name:BRANDIE
Middle Name:MARIE
Last Name:CARLTON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5031 KING COTTON LN
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23112-2853
Mailing Address - Country:US
Mailing Address - Phone:804-617-0287
Mailing Address - Fax:804-447-6383
Practice Address - Street 1:101 BUFORD RD STE 101
Practice Address - Street 2:
Practice Address - City:NORTH CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23235-5292
Practice Address - Country:US
Practice Address - Phone:804-447-6382
Practice Address - Fax:804-447-6383
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-24
Last Update Date:2018-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040107661041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical