Provider Demographics
NPI:1164933800
Name:GRESHAM, BRANDY N (MA, CAADC, CSAC)
Entity Type:Individual
Prefix:MS
First Name:BRANDY
Middle Name:N
Last Name:GRESHAM
Suffix:
Gender:F
Credentials:MA, CAADC, CSAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1634 SHEPPARD AVE
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23518-2933
Mailing Address - Country:US
Mailing Address - Phone:860-716-4970
Mailing Address - Fax:
Practice Address - Street 1:2461 E LITTLE CREEK RD
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23518-1294
Practice Address - Country:US
Practice Address - Phone:860-716-4970
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-20
Last Update Date:2021-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
VA0710103174101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)