Provider Demographics
NPI:1184643009
Name:WEINER, MARK W (LPC ,LMFT)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:W
Last Name:WEINER
Suffix:
Gender:M
Credentials:LPC ,LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3108 N PARHAM RD STE 200A
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23294-4420
Mailing Address - Country:US
Mailing Address - Phone:804-346-0870
Mailing Address - Fax:804-290-0474
Practice Address - Street 1:3108 N PARHAM RD STE 200A
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23294-4420
Practice Address - Country:US
Practice Address - Phone:804-346-0870
Practice Address - Fax:804-290-0474
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701000876101YP2500X
VA0717000082106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA5400546Medicaid