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NPI Code Detail

MEDICARE: MRS. HEATHER BRADY RESIDENT IN MARRIAGE

MEDICARE: MRS. HEATHER BRADY RESIDENT IN MARRIAGE
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106H00000XMarriage & Family Therapist0730000699VA

General Provider Information

NPI Number : 1417649732
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. HEATHER BRADY RESIDENT IN MARRIAGE
Provider Business Mailing Address
First Line : 2713 DEERFIELD CRES
Second Line :
City : CHESAPEAKE
State : VA
Zip : 23321-2447
Country : US
Telephone Number : 757-956-6100
Fax Number : 757-956-6101
Provider Business Practice Location Address
First Line : 3217 WESTERN BRANCH BLVD STE C
Second Line :
City : CHESAPEAKE
State : VA
Zip : 23321-5235
Country : US
Telephone Number : 757-956-6100
Fax Number : 757-956-6101
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/24/2023
Last Update Date : 05/24/2023

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Directions to “ MRS. HEATHER BRADY RESIDENT IN MARRIAGE” Practice Location

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