Provider Demographics
NPI:1710018957
Name:BRANDT, PAMELA JOAN (LCSW)
Entity Type:Individual
Prefix:MS
First Name:PAMELA
Middle Name:JOAN
Last Name:BRANDT
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 1:704 TUPELO XING
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23320-9250
Mailing Address - Country:US
Mailing Address - Phone:757-641-5541
Mailing Address - Fax:757-547-1259
Practice Address - Street 1:704 TUPELO XING
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-9250
Practice Address - Country:US
Practice Address - Phone:757-641-5541
Practice Address - Fax:757-547-1259
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0904002769101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health