Healthcare Provider Details

I. General information

NPI: 1417860271
Provider Name (Legal Business Name): BRENNA MACK COUNSELING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2026
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2011 NORMANDSTONE DR
MIDLOTHIAN VA
23113-9670
US

IV. Provider business mailing address

2011 NORMANDSTONE DR
MIDLOTHIAN VA
23113-9670
US

V. Phone/Fax

Practice location:
  • Phone: 757-771-6406
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: BRENNA MACK
Title or Position: OWNER
Credential: LPC
Phone: 757-771-6406