Provider Demographics
NPI:1003442286
Name:CHAVIS, BRENDA BURRUSS (MD)
Entity Type:Individual
Prefix:MS
First Name:BRENDA
Middle Name:BURRUSS
Last Name:CHAVIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:324 MAIN ST UNIT 466
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20725-7520
Mailing Address - Country:US
Mailing Address - Phone:404-550-1684
Mailing Address - Fax:240-366-1774
Practice Address - Street 1:6391 ROWANBERRY DR APT 414
Practice Address - Street 2:
Practice Address - City:ELKRIDGE
Practice Address - State:MD
Practice Address - Zip Code:21075-7032
Practice Address - Country:US
Practice Address - Phone:404-550-1684
Practice Address - Fax:240-366-1774
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-19
Last Update Date:2022-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC11224101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health