Healthcare Provider Details

I. General information

NPI: 1851451561
Provider Name (Legal Business Name): PEGGY SPENCE BRENNAN APRN, CNS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/11/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10520 WARWICK AVE SUITE B2
FAIRFAX VA
22030-3100
US

IV. Provider business mailing address

10520 WARWICK AVE SUITE B2
FAIRFAX VA
22030-3100
US

V. Phone/Fax

Practice location:
  • Phone: 703-385-9665
  • Fax:
Mailing address:
  • Phone: 703-385-9665
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0015000452
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: