Provider Demographics
NPI:1053083246
Name:GARDNER, BRENDA S (LPC)
Entity type:Individual
Prefix:
First Name:BRENDA
Middle Name:S
Last Name:GARDNER
Suffix:
Gender:
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4415 CARA HILL LN
Mailing Address - Street 2:
Mailing Address - City:CHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:23831-6816
Mailing Address - Country:US
Mailing Address - Phone:804-467-5176
Mailing Address - Fax:
Practice Address - Street 1:5309 COMMONWEALTH CENTRE PKWY STE 401
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23112-2633
Practice Address - Country:US
Practice Address - Phone:804-594-3690
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-05
Last Update Date:2025-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701010878101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty