Provider Demographics
NPI:1750345310
Name:MCGILLIVRAY SMITH, BRENDA (LPC LMFT)
Entity type:Individual
Prefix:
First Name:BRENDA
Middle Name:
Last Name:MCGILLIVRAY SMITH
Suffix:
Gender:F
Credentials:LPC LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 OLD MILL LN
Mailing Address - Street 2:
Mailing Address - City:BROADWAY
Mailing Address - State:VA
Mailing Address - Zip Code:22815-2754
Mailing Address - Country:US
Mailing Address - Phone:540-901-9000
Mailing Address - Fax:540-901-9000
Practice Address - Street 1:250 OLD MILL LN
Practice Address - Street 2:
Practice Address - City:BROADWAY
Practice Address - State:VA
Practice Address - Zip Code:22815-2754
Practice Address - Country:US
Practice Address - Phone:540-901-9000
Practice Address - Fax:540-901-9000
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-12
Last Update Date:2022-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0717000424106H00000X
VA0701002606101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA005408806Medicaid