Healthcare Provider Details

I. General information

NPI: 1164008819
Provider Name (Legal Business Name): BRENDAN O'CONNOR LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2021
Last Update Date: 04/03/2024
Certification Date: 04/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

308 GEORGE WASHINGTON HWY N STE 2
CHESAPEAKE VA
23323-1852
US

IV. Provider business mailing address

308 GEORGE WASHINGTON HWY N STE 2
CHESAPEAKE VA
23323-1852
US

V. Phone/Fax

Practice location:
  • Phone: 757-773-6130
  • Fax:
Mailing address:
  • Phone: 757-773-6130
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0701010352
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: