Clinton Lee Brogdon, LPC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

0701007411 Issued in VA

Practice address

11204 Waples Mill Rd
Fairfax, VA 22030-6036

Phone

(703) 218-8500

Fax

(703) 359-0463

NPI assigned

Jun 10, 2017

Last updated

Apr 1, 2020By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1497052800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1585699200000",
    "number": "1457880684",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 230444",
            "city": "CENTREVILLE",
            "state": "VA",
            "postal_code": "201200444",
            "telephone_number": "571-528-0805"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11204 WAPLES MILL RD",
            "city": "FAIRFAX",
            "state": "VA",
            "postal_code": "220306036",
            "telephone_number": "703-218-8500",
            "fax_number": "703-359-0463"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "14143 Robert Paris Ct",
            "address_purpose": "LOCATION",
            "city": "Chantilly",
            "state": "VA",
            "postal_code": "201514201",
            "country_code": "US",
            "telephone_number": "571-528-0805",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BROGDON",
        "first_name": "CLINTON",
        "middle_name": "LEE",
        "credential": "LPC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2017-06-10",
        "last_updated": "2020-04-01",
        "certification_date": "2020-04-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "VA",
            "license": "0701007411",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Molly Boyer Broache, W.H.N.P.
• Elizabeth Anne Brocato, LCSW
• Nancy Farmer Brockway, OT/L
• Richard Arthur Broderick, MD
• Phyllis Brodie, PHD
• Erin Quigley Brognano, MS, OTR/L
• Nancy Maxine Bromberg, VMD
• Najah Bronson
• Mary Elizabeth Brooke, OTR/L
• Amanda C Brooks, CRNP

• Professional Counselor in Fairfax, VA
• Providers in Fairfax, VA by specialty
• Professional Counselor in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 1, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.