Provider Demographics
NPI:1376802280
Name:WISEMAN, ANNE ELIZABETH (LPC)
Entity Type:Individual
Prefix:MRS
First Name:ANNE
Middle Name:ELIZABETH
Last Name:WISEMAN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:MS
Other - First Name:ANNE
Other - Middle Name:ELIZABETH
Other - Last Name:WELLS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6801 NASHVILLE RD
Mailing Address - Street 2:
Mailing Address - City:LANHAM
Mailing Address - State:MD
Mailing Address - Zip Code:20706-3762
Mailing Address - Country:US
Mailing Address - Phone:240-328-8893
Mailing Address - Fax:
Practice Address - Street 1:6801 NASHVILLE RD
Practice Address - Street 2:
Practice Address - City:LANHAM
Practice Address - State:MD
Practice Address - Zip Code:20706-3762
Practice Address - Country:US
Practice Address - Phone:240-328-8893
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-11
Last Update Date:2012-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC4401101YP2500X
DCPRC14187101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD0541052 00Medicaid