Provider Demographics
NPI:1407604812
Name:TRACE, BRANDI (MA, LPC-R)
Entity type:Individual
Prefix:MRS
First Name:BRANDI
Middle Name:
Last Name:TRACE
Suffix:
Gender:F
Credentials:MA, LPC-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3961 SPRINGFIELD RD
Mailing Address - Street 2:
Mailing Address - City:MEHERRIN
Mailing Address - State:VA
Mailing Address - Zip Code:23954-2406
Mailing Address - Country:US
Mailing Address - Phone:434-294-4266
Mailing Address - Fax:
Practice Address - Street 1:3961 SPRINGFIELD RD
Practice Address - Street 2:
Practice Address - City:MEHERRIN
Practice Address - State:VA
Practice Address - Zip Code:23954-2406
Practice Address - Country:US
Practice Address - Phone:434-294-4266
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-09
Last Update Date:2024-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0704016886101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health