Provider Demographics
NPI:1316040306
Name:MOORE, WENDY WAHL (LPC)
Entity Type:Individual
Prefix:MS
First Name:WENDY
Middle Name:WAHL
Last Name:MOORE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7611 RANGE RD
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22306-2425
Mailing Address - Country:US
Mailing Address - Phone:410-703-2543
Mailing Address - Fax:
Practice Address - Street 1:2800 S SHIRLINGTON RD STE 350
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22206-3617
Practice Address - Country:US
Practice Address - Phone:703-379-9311
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-06
Last Update Date:2023-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLCPC 1603101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD008383600Medicaid