Provider Demographics
NPI:1558323402
Name:DUNGAN, WANDA J (LPC)
Entity Type:Individual
Prefix:
First Name:WANDA
Middle Name:J
Last Name:DUNGAN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9228 GEORGE WASHINGTON MEMORIAL HWY
Mailing Address - Street 2:
Mailing Address - City:GLOUCESTER
Mailing Address - State:VA
Mailing Address - Zip Code:23061-4162
Mailing Address - Country:US
Mailing Address - Phone:804-693-5068
Mailing Address - Fax:804-693-7407
Practice Address - Street 1:414 MAIN ST
Practice Address - Street 2:
Practice Address - City:WARSAW
Practice Address - State:VA
Practice Address - Zip Code:22572-4291
Practice Address - Country:US
Practice Address - Phone:804-333-3671
Practice Address - Fax:804-333-3657
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-05
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0710001142101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA331729OtherTRICARE
VA2055241OtherCIGNA
VAO81143OtherSOUTHERN HEALTH
VA264159OtherVALUE OPTIONS
VA326873OtherANTHEM
VA326873OtherHEALTHKEEPERS
VA326873Medicaid
VAO81143Medicaid