Provider Demographics
NPI:1487646204
Name:WICHLACZ, CASIMER RICHARD (MSW)
Entity Type:Individual
Prefix:MR
First Name:CASIMER
Middle Name:RICHARD
Last Name:WICHLACZ
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9810 BRIGHTLEA DR
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22181-6003
Mailing Address - Country:US
Mailing Address - Phone:703-281-5337
Mailing Address - Fax:
Practice Address - Street 1:9810 BRIGHTLEA DR
Practice Address - Street 2:
Practice Address - City:VIENNA
Practice Address - State:VA
Practice Address - Zip Code:22181-6003
Practice Address - Country:US
Practice Address - Phone:703-281-5337
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-18
Last Update Date:2011-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040059231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical