Healthcare Provider Details

I. General information

NPI: 1295670578
Provider Name (Legal Business Name): BRANDON WILLIAMS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/22/2026
Last Update Date: 04/22/2026
Certification Date: 04/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

780 LYNNHAVEN PKWY
VIRGINIA BEACH VA
23452-7332
US

IV. Provider business mailing address

524 NEWPORT NEWS AVE
HAMPTON VA
23669-3929
US

V. Phone/Fax

Practice location:
  • Phone: 804-207-3878
  • Fax:
Mailing address:
  • Phone: 757-692-8554
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-26-526555
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: