Provider Demographics
NPI:1477806867
Name:HERNDON, VIRGINIA BROOKE (MS, LMFT)
Entity Type:Individual
Prefix:MS
First Name:VIRGINIA
Middle Name:BROOKE
Last Name:HERNDON
Suffix:
Gender:F
Credentials:MS, LMFT
Other - Prefix:
Other - First Name:GIA
Other - Middle Name:
Other - Last Name:HERNDON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS LMFT
Mailing Address - Street 1:2000 L ST
Mailing Address - Street 2:SUITE 150
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95811-4254
Mailing Address - Country:US
Mailing Address - Phone:661-319-1560
Mailing Address - Fax:
Practice Address - Street 1:2000 L STREET
Practice Address - Street 2:SUITE 150
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95811
Practice Address - Country:US
Practice Address - Phone:661-319-1560
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-22
Last Update Date:2014-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA40799106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist