Provider Demographics
NPI:1164008819
Name:O'CONNOR, BRENDAN (LPC)
Entity Type:Individual
Prefix:
First Name:BRENDAN
Middle Name:
Last Name:O'CONNOR
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:308 GEORGE WASHINGTON HWY N STE 2
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23323-1852
Mailing Address - Country:US
Mailing Address - Phone:757-773-6130
Mailing Address - Fax:
Practice Address - Street 1:308 GEORGE WASHINGTON HWY N STE 2
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23323-1852
Practice Address - Country:US
Practice Address - Phone:757-773-6130
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-23
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701010352101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional