Provider Demographics
NPI:1497701213
Name:COFFIELD, WENDY (PHD)
Entity Type:Individual
Prefix:MS
First Name:WENDY
Middle Name:
Last Name:COFFIELD
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:MS
Other - First Name:WENDY
Other - Middle Name:
Other - Last Name:GELFAND
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD
Mailing Address - Street 1:3340 GLEN EDEN QUAY
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23452
Mailing Address - Country:US
Mailing Address - Phone:757-340-8888
Mailing Address - Fax:
Practice Address - Street 1:700 INDEPENDENCE CIRCLE
Practice Address - Street 2:SUITE 3D INDEPENDENCE THERAPY CENTER
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23455
Practice Address - Country:US
Practice Address - Phone:757-473-8533
Practice Address - Fax:757-456-0616
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2009-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1941103T00000X
VA0810001062103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA7703953Medicaid
VA006335I45Medicare PIN