Provider Demographics
NPI:1588321103
Name:CROWDER, BRENDA BLANCHARD (LPC, CSOTP)
Entity type:Individual
Prefix:MRS
First Name:BRENDA
Middle Name:BLANCHARD
Last Name:CROWDER
Suffix:
Gender:F
Credentials:LPC, CSOTP
Other - Prefix:MS
Other - First Name:BRENDA
Other - Middle Name:ALMIRA
Other - Last Name:BLANCHARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC, CSOTP
Mailing Address - Street 1:PO BOX 548
Mailing Address - Street 2:
Mailing Address - City:BURKEVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:23922-0548
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4901 E PATRICK HENRY HWY
Practice Address - Street 2:
Practice Address - City:BURKEVILLE
Practice Address - State:VA
Practice Address - Zip Code:23922-3454
Practice Address - Country:US
Practice Address - Phone:804-766-3079
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-18
Last Update Date:2025-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701011129101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional