Healthcare Provider Details

I. General information

NPI: 1629124177
Provider Name (Legal Business Name): MICHAEL JOSEPH BRENNEIS LPC, LMFT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/26/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

46 S GLEBE RD SUITE 103
ARLINGTON VA
22204-1655
US

IV. Provider business mailing address

2309 N KENTUCKY ST
ARLINGTON VA
22205-3222
US

V. Phone/Fax

Practice location:
  • Phone: 703-521-6004
  • Fax:
Mailing address:
  • Phone: 703-534-0740
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0701001753
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number0717000011
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: