Provider Demographics
NPI:1558685222
Name:LUNDIE, BRENDA COLE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:BRENDA
Middle Name:COLE
Last Name:LUNDIE
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 1:17201 JEFFERSON DAVIS HIGHWAY
Mailing Address - Street 2:
Mailing Address - City:COLONIAL HEIGHTS
Mailing Address - State:VA
Mailing Address - Zip Code:23834
Mailing Address - Country:US
Mailing Address - Phone:804-526-0424
Mailing Address - Fax:804-526-0748
Practice Address - Street 1:17201 JEFF. DAVIS HWY
Practice Address - Street 2:
Practice Address - City:COL. HGTS
Practice Address - State:VA
Practice Address - Zip Code:23834
Practice Address - Country:US
Practice Address - Phone:804-526-0424
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-24
Last Update Date:2010-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0904003631101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor