Provider Demographics
NPI:1497322994
Name:WYCHE, BRENDA C (LPC)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:C
Last Name:WYCHE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1118 W WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:PETERSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23803-3921
Mailing Address - Country:US
Mailing Address - Phone:804-203-4477
Mailing Address - Fax:
Practice Address - Street 1:315 BROWN ST
Practice Address - Street 2:
Practice Address - City:PETERSBURG
Practice Address - State:VA
Practice Address - Zip Code:23803-4232
Practice Address - Country:US
Practice Address - Phone:804-203-4477
Practice Address - Fax:804-805-2152
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-04
Last Update Date:2021-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701010383101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional