Provider Demographics
NPI:1366543175
Name:BRAGG, SUSAN K (LPC)
Entity type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:K
Last Name:BRAGG
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5409 FALMOUTH ST
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23230-2101
Mailing Address - Country:US
Mailing Address - Phone:804-920-6397
Mailing Address - Fax:
Practice Address - Street 1:5409 FALMOUTH ST
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23230-2101
Practice Address - Country:US
Practice Address - Phone:804-920-6397
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2020-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701003138101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA383711OtherANTHEM PROVIDER NUMBER