Basic Information
| Provider Information | |||||||||
| NPI: | 1407868110 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MICHAEL | ||||||||
| FirstName: | BRENDA | ||||||||
| MiddleName: | K | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | LPC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1430 | ||||||||
| Address2: | |||||||||
| City: | HARRISONBURG | ||||||||
| State: | VA | ||||||||
| PostalCode: | 228031430 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5405645636 | ||||||||
| FaxNumber: | 5404334123 | ||||||||
| Practice Location | |||||||||
| Address1: | 644 UNIVERSITY BLVD | ||||||||
| Address2: | |||||||||
| City: | HARRISONBURG | ||||||||
| State: | VA | ||||||||
| PostalCode: | 228013750 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5405645629 | ||||||||
| FaxNumber: | 5404334338 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/12/2006 | ||||||||
| LastUpdateDate: | 04/07/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | 0701000830 | VA | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
ID Information
| ID | Type | State | Issuer | Description | 084552M | 01 | VA | SENTARA PROVIDER NUMBER | OTHER | 1164637518 | 01 | VA | GROUP NPI NUMBER | OTHER | 11426850 | 01 | VA | CAQH PROVIDER NUMBER | OTHER | 177051 | 01 | VA | ANTHEM PROVIDER NUMBER | OTHER | 2240808 | 01 | VA | CIGNA PROVIDER NUMBER | OTHER | 432609 | 01 | VA | VALUE OPTIONS PROVIDER NO | OTHER | 010069593 | 05 | VA | MEDICAID | 251026 | 01 | VA | COMPSYCH PROVIDER NUMBER | OTHER | C05754 | 01 | VA | MEDICARE GROUP NUMBER | OTHER |