Provider Demographics
NPI:1265029029
Name:BRACE, SA'DERIA NACHET (LCSW)
Entity Type:Individual
Prefix:
First Name:SA'DERIA
Middle Name:NACHET
Last Name:BRACE
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 1:3634 S PLAZA TRL STE 204
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23452-3351
Mailing Address - Country:US
Mailing Address - Phone:757-774-3379
Mailing Address - Fax:
Practice Address - Street 1:3634 S PLAZA TRL STE 204
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23452-3351
Practice Address - Country:US
Practice Address - Phone:757-774-3379
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-28
Last Update Date:2021-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040125381041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical