Individual
MR. MARK W BRAGG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LPC
Contact information
Practice address
4209 JOHN SILVER RD, VIRGINIA BEACH, VA 23455-2131
(757) 363-2825
(757) 363-2825
Mailing address
4209 JOHN SILVER RD, VIRGINIA BEACH, VA 23455-2131
(757) 363-2825
(757) 363-2825
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
0701003261
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0701003261
LICENSE NUMBER
VA
Enumeration date
01/12/2007
Last updated
07/08/2007
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