Healthcare Provider Details

I. General information

NPI: 1669362570
Provider Name (Legal Business Name): DRBACW INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/03/2025
Last Update Date: 07/03/2025
Certification Date: 07/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1309 JAMESTOWN RD STE 201
WILLIAMSBURG VA
23185-3380
US

IV. Provider business mailing address

1309 JAMESTOWN RD STE 201
WILLIAMSBURG VA
23185-3380
US

V. Phone/Fax

Practice location:
  • Phone: 757-941-8182
  • Fax: 757-500-0134
Mailing address:
  • Phone: 757-941-8182
  • Fax: 757-500-0134

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: DR. BRENT C PETERSON
Title or Position: OWNER
Credential: PH.D M.S.
Phone: 757-941-8182