Healthcare Provider Details

I. General information

NPI: 1306315221
Provider Name (Legal Business Name): BRANDY KELLY RICHESON PHD, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/20/2018
Last Update Date: 11/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3101 AMERICAN LEGION RD STE 23
CHESAPEAKE VA
23321-5655
US

IV. Provider business mailing address

4589 KENNEBECK AVE
NORFOLK VA
23513-3678
US

V. Phone/Fax

Practice location:
  • Phone: 757-483-2580
  • Fax: 757-483-2939
Mailing address:
  • Phone: 175-721-8505
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number0600883
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0701006615
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: