Active NPI
Mark W Bragg, LPC
- Professional Counselor
- Virginia Beach, VA
National Provider Identifier
1831249523
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 0701003261
- Practice address
- 4209 John Silver Rd
Virginia Beach, VA 23455-2131 - Phone
- (757) 363-2825
- Fax
- (757) 363-2825
- NPI assigned
- Jan 12, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 0701003261 | VA | Primary |
Addresses
Primary practice location
4209 John Silver Rd
Virginia Beach, VA 23455-2131
Mailing address
4209 John Silver Rd
Virginia Beach, VA 23455-2131
Phone (757) 363-2825
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0701003261 | Other | VA | LICENSE NUMBER |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0701003261 | VA | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1168560000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1831249523",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4209 JOHN SILVER RD",
"city": "VIRGINIA BEACH",
"state": "VA",
"postal_code": "234552131",
"telephone_number": "757-363-2825",
"fax_number": "757-363-2825"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4209 JOHN SILVER RD",
"city": "VIRGINIA BEACH",
"state": "VA",
"postal_code": "234552131",
"telephone_number": "757-363-2825",
"fax_number": "757-363-2825"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BRAGG",
"first_name": "MARK",
"middle_name": "W",
"name_prefix": "Mr.",
"credential": "LPC",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-01-12",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "VA",
"license": "0701003261",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "LICENSE NUMBER",
"identifier": "0701003261",
"state": "VA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Virginia Beach, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.