Provider Demographics
NPI:1508311044
Name:WEIDINGER, AMY
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:WEIDINGER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 BEULAH RD NE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22180-4745
Mailing Address - Country:US
Mailing Address - Phone:571-334-5290
Mailing Address - Fax:
Practice Address - Street 1:120 BEULAH RD NE
Practice Address - Street 2:SUITE 201
Practice Address - City:VIENNA
Practice Address - State:VA
Practice Address - Zip Code:22180-4745
Practice Address - Country:US
Practice Address - Phone:571-334-5290
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-24
Last Update Date:2016-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health