Provider Demographics
NPI:1083991608
Name:BURKHOLDER, BRENDA (LPC)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:
Last Name:BURKHOLDER
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 460
Mailing Address - Street 2:
Mailing Address - City:GLOUCESTER
Mailing Address - State:VA
Mailing Address - Zip Code:23061-0460
Mailing Address - Country:US
Mailing Address - Phone:804-695-2557
Mailing Address - Fax:804-695-0110
Practice Address - Street 1:7319 MARTIN ST
Practice Address - Street 2:2
Practice Address - City:GLOUCESTER
Practice Address - State:VA
Practice Address - Zip Code:23061-5358
Practice Address - Country:US
Practice Address - Phone:804-695-2557
Practice Address - Fax:804-695-0110
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-10
Last Update Date:2011-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701005130101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional