Provider Demographics
NPI:1043876014
Name:NETTINGHAM, BRITTANY L (LPC, LSATP)
Entity Type:Individual
Prefix:
First Name:BRITTANY
Middle Name:L
Last Name:NETTINGHAM
Suffix:
Gender:F
Credentials:LPC, LSATP
Other - Prefix:
Other - First Name:BRITTANY
Other - Middle Name:L
Other - Last Name:VICKERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:816 GREENBRIER CIR STE 100
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23320-2645
Mailing Address - Country:US
Mailing Address - Phone:757-301-8747
Mailing Address - Fax:
Practice Address - Street 1:816 GREENBRIER CIR STE 100
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-2645
Practice Address - Country:US
Practice Address - Phone:757-301-8747
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-15
Last Update Date:2023-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0718000405101YA0400X
VA0701008021101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA30016125470005Medicaid