Provider Demographics
NPI:1043446594
Name:WYKLE, NADINE (LPC; CSAC)
Entity Type:Individual
Prefix:
First Name:NADINE
Middle Name:
Last Name:WYKLE
Suffix:
Gender:F
Credentials:LPC; CSAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:311 S MONROE AVE
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:24426-1635
Mailing Address - Country:US
Mailing Address - Phone:540-965-2100
Mailing Address - Fax:
Practice Address - Street 1:311 S MONROE AVE
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:VA
Practice Address - Zip Code:24426-1635
Practice Address - Country:US
Practice Address - Phone:540-965-2100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-10
Last Update Date:2009-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701004573101YM0800X
WV929101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health