Healthcare Provider Details

I. General information

NPI: 1922135540
Provider Name (Legal Business Name): JOHN L BRUMFIELD LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/28/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1657 MERRIMAC TRL
WILLIAMSBURG VA
23185-5624
US

IV. Provider business mailing address

611 ASHFORD PL
NEWPORT NEWS VA
23602-4900
US

V. Phone/Fax

Practice location:
  • Phone: 757-220-3200
  • Fax: 757-253-4671
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0701002663
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: