Provider Demographics
NPI:1871397463
Name:BRAVEE BEHAVIORAL HOLISTIC HEALTH, LLC
Entity type:Organization
Organization Name:BRAVEE BEHAVIORAL HOLISTIC HEALTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BEHAVIOR HEALTH DIRETOR
Authorized Official - Prefix:DR
Authorized Official - First Name:REGINA
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:LGADC
Authorized Official - Phone:240-704-4002
Mailing Address - Street 1:311 LONG TRAIL TER
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-7766
Mailing Address - Country:US
Mailing Address - Phone:910-546-0102
Mailing Address - Fax:
Practice Address - Street 1:311 LONG TRAIL TER
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-7766
Practice Address - Country:US
Practice Address - Phone:240-704-4002
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-02
Last Update Date:2025-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty