Provider Demographics
NPI:1871500785
Name:WILLIAMS, BRENDA J (LCSW, DSL)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:J
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:LCSW, DSL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:334 BROUT DR
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:VA
Mailing Address - Zip Code:23666-3619
Mailing Address - Country:US
Mailing Address - Phone:757-289-6693
Mailing Address - Fax:757-825-1789
Practice Address - Street 1:334 BROUT DR
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23666-3619
Practice Address - Country:US
Practice Address - Phone:757-289-6693
Practice Address - Fax:757-825-1789
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-02
Last Update Date:2009-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040016671041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA008933308Medicaid