Provider Demographics
NPI:1386660124
Name:WAGES, BETTYE (LCPC)
Entity Type:Individual
Prefix:
First Name:BETTYE
Middle Name:
Last Name:WAGES
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 MERCANTILE LN
Mailing Address - Street 2:232
Mailing Address - City:LARGO
Mailing Address - State:MD
Mailing Address - Zip Code:20774-5341
Mailing Address - Country:US
Mailing Address - Phone:301-583-0001
Mailing Address - Fax:301-583-3404
Practice Address - Street 1:1400 MERCANTILE LN
Practice Address - Street 2:232
Practice Address - City:LARGO
Practice Address - State:MD
Practice Address - Zip Code:20774-5341
Practice Address - Country:US
Practice Address - Phone:301-583-0001
Practice Address - Fax:301-583-3404
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC2177101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional