Provider Demographics
NPI:1629124177
Name:BRENNEIS, MICHAEL JOSEPH (LPC, LMFT)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:JOSEPH
Last Name:BRENNEIS
Suffix:
Gender:M
Credentials:LPC, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2309 N KENTUCKY ST
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22205-3222
Mailing Address - Country:US
Mailing Address - Phone:703-534-0740
Mailing Address - Fax:
Practice Address - Street 1:46 S GLEBE RD
Practice Address - Street 2:SUITE 103
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22204-1655
Practice Address - Country:US
Practice Address - Phone:703-521-6004
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701001753101YP2500X
VA0717000011106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist