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 1:800 BOULDER SPRINGS DR
Mailing Address - Street 2:APARTMENT #B3
Mailing Address - City:NORTH CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23225-5535
Mailing Address - Country:US
Mailing Address - Phone:404-509-3281
Mailing Address - Fax:
Practice Address - Street 1:2727 ENTERPRISE PKWY STE 202
Practice Address - Street 2:
Practice Address - City:HENRICO
Practice Address - State:VA
Practice Address - Zip Code:23294-6341
Practice Address - Country:US
Practice Address - Phone:804-261-2090
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-05
Last Update Date:2022-04-12
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