Provider Demographics
NPI:1922468396
Name:PETERSON, BRANDY (LPC)
Entity Type:Individual
Prefix:
First Name:BRANDY
Middle Name:
Last Name:PETERSON
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 1:239 E 5TH ST
Mailing Address - Street 2:
Mailing Address - City:CHASE CITY
Mailing Address - State:VA
Mailing Address - Zip Code:23924-1431
Mailing Address - Country:US
Mailing Address - Phone:434-372-3002
Mailing Address - Fax:434-372-3007
Practice Address - Street 1:239 E 5TH ST
Practice Address - Street 2:
Practice Address - City:CHASE CITY
Practice Address - State:VA
Practice Address - Zip Code:23924-1431
Practice Address - Country:US
Practice Address - Phone:434-372-3002
Practice Address - Fax:434-372-3007
Is Sole Proprietor?:No
Enumeration Date:2016-02-29
Last Update Date:2016-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701006110101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health