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General NPI Number Information
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NPI Number | 1366762270
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Entity Type | Organization
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Legal Business Name | BRENDA LEE DAVIS MA LPC LLC
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Dates
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Enumeration Date | 06/03/2010
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Last Update Date | 04/03/2020
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Provider Practice Location Address
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Address Line | 3217 WESTERN BRANCH BLVD SUITE C
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City | CHESAPEAKE
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State | VA
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Zip | 23321
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Country | US
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Telephone | 757-956-6100
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Fax | 757-956-6101
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Provider Business Mailing Address
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Address Line | 2713 DEERFIELD CRES
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City | CHESAPEAKE
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State | VA
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Zip | 23321-2447
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Country | US
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Telephone | 757-956-6100
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Fax | 757-956-6101
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Authorized Official
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Title or Position | OWNER
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Name | MRS. BRENDA LEE DAVIS
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Credential | MA, LPC, RPT-S
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Telephone | 757-956-6100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 701003883
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License Number State | VA
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