Organization
BROOKSIDE FAMILY THERAPY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KELLY AUSTIN LMFT (OWNER)
(571) 331-9704
Entity
Organization
Contact information
Practice address
9105A OWENS DR STE 102, MANASSAS PARK, VA 20111-4852
(571) 445-0265
(855) 755-7769
Mailing address
7118 KNOTTY OAK LN, MANASSAS, VA 20112-3235
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
101YP2500X
Professional Counselor
—
—
106H00000X
Marriage & Family Therapist
—
—
Other
Enumeration date
01/04/2024
Last updated
01/04/2024
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