Provider Demographics
NPI:1316109077
Name:GRAGNANI, CARMEN ANNE (LPC)
Entity type:Individual
Prefix:MRS
First Name:CARMEN
Middle Name:ANNE
Last Name:GRAGNANI
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:CARMEN
Other - Middle Name:GRAGNANI
Other - Last Name:SLAYTON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPC
Mailing Address - Street 1:4508 HANOVER AVE
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23221-1822
Mailing Address - Country:US
Mailing Address - Phone:804-355-0908
Mailing Address - Fax:
Practice Address - Street 1:5931 HARBOUR PARK DR
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23112-2163
Practice Address - Country:US
Practice Address - Phone:804-639-1136
Practice Address - Fax:804-639-5584
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-25
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701004361101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor