Provider Demographics
NPI:1942677885
Name:ROZIER-CLARK, BRENDA
Entity Type:Individual
Prefix:DR
First Name:BRENDA
Middle Name:
Last Name:ROZIER-CLARK
Suffix:
Gender:F
Credentials:
Other - Prefix:DR
Other - First Name:BRENDA
Other - Middle Name:ROZIER
Other - Last Name:CLARK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ED D
Mailing Address - Street 1:8208 GREELEY BLVD
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:22152-3043
Mailing Address - Country:US
Mailing Address - Phone:703-644-4134
Mailing Address - Fax:
Practice Address - Street 1:5417C BACKLICK RD
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:VA
Practice Address - Zip Code:22151-3915
Practice Address - Country:US
Practice Address - Phone:703-866-9999
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-26
Last Update Date:2015-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701002536101YP2500X
VA0717000802106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist