Provider Demographics
NPI:1083894729
Name:WIETZ, CHERYL (LCSW)
Entity Type:Individual
Prefix:MISS
First Name:CHERYL
Middle Name:
Last Name:WIETZ
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 ROWELL CT
Mailing Address - Street 2:SUITE 300
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22046-3126
Mailing Address - Country:US
Mailing Address - Phone:703-533-1996
Mailing Address - Fax:703-533-2100
Practice Address - Street 1:101 ROWELL CT
Practice Address - Street 2:SUITE 300
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22046-3126
Practice Address - Country:US
Practice Address - Phone:703-533-1996
Practice Address - Fax:703-533-2100
Is Sole Proprietor?:No
Enumeration Date:2007-11-09
Last Update Date:2007-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040013421041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical