Healthcare Provider Details

I. General information

NPI: 1841020450
Provider Name (Legal Business Name): CHRISTINE ABIGAIL BRUNDAGE LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/07/2024
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11713 JEFFERSON AVE
NEWPORT NEWS VA
23606-2400
US

IV. Provider business mailing address

22 MAMMOTH OAK RD
NEWPORT NEWS VA
23606-1612
US

V. Phone/Fax

Practice location:
  • Phone: 757-503-2819
  • Fax:
Mailing address:
  • Phone: 757-989-9496
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0904017213
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: