Organization
BRAINIAC NEUROFEEDBACK COUNSELING AND COACHING
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHERYL NORTH DESVERNINE (PRESIDENT)
(804) 357-2483
Entity
Organization
Contact information
Practice address
9327 RAVENSWORTH CT, MECHANICSVILLE, VA 23116-8708
(804) 357-2483
Mailing address
9327 RAVENSWORTH CT, MECHANICSVILLE, VA 23116-8708
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
101YM0800X
Mental Health Counselor
—
—
101YP2500X
Professional Counselor
Primary
—
—
2084B0040X
Behavioral Neurology & Neuropsychiatry Physician
—
—
2084S0012X
Sleep Medicine (Psychiatry & Neurology) Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0701002731
LICENSED PROFESSIONAL COUNSELOR
VA
Enumeration date
02/04/2022
Last updated
02/04/2022
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