NPI 1477323152 · live from the CMS NPI Registry
Brookside Family Therapy, LLC
Counselor, Mental Health in Manassas, VA. National Provider Identifier 1477323152, active.
NPI record
| NPI | 1477323152 Type 2 · organization |
|---|---|
| Status | Active |
| Primary specialty | Counselor, Mental Health 101YM0800X |
| Practice location | 8781 Mathis Ave, Manassas, VA 20110 |
| Practice phone | 571-445-0265 |
| Mailing address | 7118 Knotty Oak Ln, Manassas, VA 20112 |
| Enumerated | January 4, 2024 |
| Last updated | August 29, 2026 |
| Authorized official | Kelly Austin, Owner |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Counselor, Mental Health primary | 101YM0800X | — |
| Counselor, Professional | 101YP2500X | — |
| Marriage & Family Therapist | 106H00000X | — |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.