Individual
BRANDY NICKOLE BENNETT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LBA
Contact information
Practice address
174 COSTELLO DR, WINCHESTER, VA 22602-4306
(540) 662-7007
(540) 662-1311
Mailing address
174 COSTELLO DR, WINCHESTER, VA 22602-4306
(540) 662-7007
(540) 662-1311
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
0133000762
VA
Other
Enumeration date
05/31/2016
Last updated
05/31/2016
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