Provider Demographics
NPI:1053647586
Name:TYLER, WANDA ARLENE (LPC)
Entity Type:Individual
Prefix:MS
First Name:WANDA
Middle Name:ARLENE
Last Name:TYLER
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5807 GREENLEAF RD
Mailing Address - Street 2:
Mailing Address - City:CHEVERLY
Mailing Address - State:MD
Mailing Address - Zip Code:20785-1115
Mailing Address - Country:US
Mailing Address - Phone:301-509-8495
Mailing Address - Fax:
Practice Address - Street 1:4201 CONN AVE NW
Practice Address - Street 2:SUITE 300
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20008-1158
Practice Address - Country:US
Practice Address - Phone:202-624-0010
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-18
Last Update Date:2009-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPRC13739101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor