Provider Demographics
NPI:1285201277
Name:WILLIAMSBURG YOUTH COUNSELING, LLC
Entity Type:Organization
Organization Name:WILLIAMSBURG YOUTH COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:DANE
Authorized Official - Middle Name:
Authorized Official - Last Name:WENDELL
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:757-879-9582
Mailing Address - Street 1:364 MCLAWS CIR STE 2
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23185-6340
Mailing Address - Country:US
Mailing Address - Phone:757-870-5203
Mailing Address - Fax:
Practice Address - Street 1:364 MCLAWS CIR STE 2
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23185-6340
Practice Address - Country:US
Practice Address - Phone:757-870-5203
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-08
Last Update Date:2023-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty