Healthcare Provider Details

I. General information

NPI: 1356553127
Provider Name (Legal Business Name): BRANDY LAINE KUZINS MA, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/04/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14904 JEFFERSON DAVIS HWY STE 411
WOODBRIDGE VA
22191-3908
US

IV. Provider business mailing address

7213 HIDDEN RIDGE CT
SPRINGFIELD VA
22152-3558
US

V. Phone/Fax

Practice location:
  • Phone: 703-490-1833
  • Fax:
Mailing address:
  • Phone: 703-644-6264
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0701003531
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: