Individual
CLINTON LEE BROGDON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LPC
Contact information
Practice address
11204 WAPLES MILL RD, FAIRFAX, VA 22030-6036
(703) 218-8500
(703) 359-0463
Mailing address
PO BOX 230444, CENTREVILLE, VA 20120-0444
(571) 528-0805
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
0701007411
VA
101YP2500X
Professional Counselor
—
—
Other
Enumeration date
06/10/2017
Last updated
04/01/2020
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