Provider Demographics
NPI:1265511638
Name:BRICE, WANDA D (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:WANDA
Middle Name:D
Last Name:BRICE
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 1:6105 ALMOND CREEK LN
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23231-4832
Mailing Address - Country:US
Mailing Address - Phone:804-222-0364
Mailing Address - Fax:804-222-0364
Practice Address - Street 1:3113 W MARSHALL ST
Practice Address - Street 2:SUITE 1C
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23230-4730
Practice Address - Country:US
Practice Address - Phone:804-377-3955
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040048391041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical