Provider Demographics
NPI:1033694138
Name:LEE, BRENDA JANINE (LCSW)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:JANINE
Last Name:LEE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3955 STRAWBERRY PLAINS RD
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23188-3401
Mailing Address - Country:US
Mailing Address - Phone:757-912-1842
Mailing Address - Fax:
Practice Address - Street 1:3955 STRAWBERRY PLAINS RD
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23188-3401
Practice Address - Country:US
Practice Address - Phone:757-912-1842
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-25
Last Update Date:2018-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040027121041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical