Provider Demographics
NPI:1417649732
Name:BRADY, HEATHER (RESIDENT IN MARRIAGE)
Entity Type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:
Last Name:BRADY
Suffix:
Gender:F
Credentials:RESIDENT IN MARRIAGE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2713 DEERFIELD CRES
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23321-2447
Mailing Address - Country:US
Mailing Address - Phone:757-956-6100
Mailing Address - Fax:757-956-6101
Practice Address - Street 1:3217 WESTERN BRANCH BLVD STE C
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23321-5235
Practice Address - Country:US
Practice Address - Phone:757-956-6100
Practice Address - Fax:757-956-6101
Is Sole Proprietor?:No
Enumeration Date:2023-05-24
Last Update Date:2023-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0730000699106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist