Provider Demographics
NPI:1316062888
Name:BRAYE-GONZALEZ, DAMITA Y (LPC, LMFT)
Entity type:Individual
Prefix:MRS
First Name:DAMITA
Middle Name:Y
Last Name:BRAYE-GONZALEZ
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:PO BOX 1182
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23327-1182
Mailing Address - Country:US
Mailing Address - Phone:757-548-5884
Mailing Address - Fax:
Practice Address - Street 1:1101 MADISON PLZ
Practice Address - Street 2:SUITE 100
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-5179
Practice Address - Country:US
Practice Address - Phone:757-548-5884
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701002336101YP2500X
VA0717000175106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA381222OtherBCBS
VA381222OtherHEALTHKEEPERS
VA5406188OtherVA PREMIER HEALTH
VA087680OtherSENTERA
VA381222OtherPRORITY HEALTHKEEPERS
VA381222OtherANTHEM