Provider Demographics
NPI:1902269004
Name:WILLIAMS, BRANDON JAMAAL ERNEST (PHD MPH)
Entity type:Individual
Prefix:DR
First Name:BRANDON
Middle Name:JAMAAL ERNEST
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:PHD MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1911 HUGUENOT RD STE 300
Mailing Address - Street 2:
Mailing Address - City:NORTH CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23235-4328
Mailing Address - Country:US
Mailing Address - Phone:804-659-3577
Mailing Address - Fax:
Practice Address - Street 1:1911 HUGUENOT RD STE 300
Practice Address - Street 2:
Practice Address - City:NORTH CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23235-4328
Practice Address - Country:US
Practice Address - Phone:804-659-3577
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-05
Last Update Date:2024-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810006196103TC0700X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program