Provider Demographics
NPI:1598354094
Name:BROADNAX, BRENDA JOYCE (LPC)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:JOYCE
Last Name:BROADNAX
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 1:1607 VILLAGE MARKET BLVD SE APT 211
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:VA
Mailing Address - Zip Code:20175-4667
Mailing Address - Country:US
Mailing Address - Phone:361-232-6340
Mailing Address - Fax:
Practice Address - Street 1:42009 VICTORY LN
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:VA
Practice Address - Zip Code:20176-6269
Practice Address - Country:US
Practice Address - Phone:703-777-0800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-11
Last Update Date:2021-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701010148101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional