Provider Demographics
NPI:1114226131
Name:MOHAMMED, WENDIE W
Entity Type:Individual
Prefix:
First Name:WENDIE
Middle Name:W
Last Name:MOHAMMED
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:619 ROBERTDALE DR
Mailing Address - Street 2:
Mailing Address - City:DUNCANSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:16635-7525
Mailing Address - Country:US
Mailing Address - Phone:814-414-2833
Mailing Address - Fax:
Practice Address - Street 1:3010 7TH AVE
Practice Address - Street 2:
Practice Address - City:ALTOONA
Practice Address - State:PA
Practice Address - Zip Code:16602-1906
Practice Address - Country:US
Practice Address - Phone:814-942-9425
Practice Address - Fax:814-942-9725
Is Sole Proprietor?:No
Enumeration Date:2011-03-16
Last Update Date:2016-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PABH000848101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor