Provider Demographics
NPI:1982635108
Name:KING, BRENDA SUE (LCSW)
Entity Type:Individual
Prefix:MISS
First Name:BRENDA
Middle Name:SUE
Last Name:KING
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:RR 3 BOX 572
Mailing Address - Street 2:
Mailing Address - City:JONESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24263-9605
Mailing Address - Country:US
Mailing Address - Phone:276-346-4437
Mailing Address - Fax:276-546-4491
Practice Address - Street 1:5610 SANDY LEWIS DR STE A
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22032-4045
Practice Address - Country:US
Practice Address - Phone:703-425-8269
Practice Address - Fax:703-425-6020
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040056321041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA182179OtherBC/BS VIRGINIA
VA008164T06Medicare ID - Type Unspecified