Provider Demographics
NPI:1306315221
Name:RICHESON, BRANDY KELLY (PHD, LPC)
Entity type:Individual
Prefix:DR
First Name:BRANDY
Middle Name:KELLY
Last Name:RICHESON
Suffix:
Gender:F
Credentials:PHD, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4589 KENNEBECK AVE
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23513-3678
Mailing Address - Country:US
Mailing Address - Phone:175-721-8505
Mailing Address - Fax:
Practice Address - Street 1:3101 AMERICAN LEGION RD STE 23
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23321-5655
Practice Address - Country:US
Practice Address - Phone:757-483-2580
Practice Address - Fax:757-483-2939
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-20
Last Update Date:2018-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0600883101YS0200X
VA0701006615101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0701006615OtherLPC LICENSE
VA0701006615OtherVIRGINIA LPC LICENSE