Provider Demographics
NPI:1578744157
Name:WAYLAND, ROSE HERR (DMIN, LPC)
Entity Type:Individual
Prefix:
First Name:ROSE
Middle Name:HERR
Last Name:WAYLAND
Suffix:
Gender:F
Credentials:DMIN, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:715 G ST SE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20003-2853
Mailing Address - Country:US
Mailing Address - Phone:202-547-0141
Mailing Address - Fax:
Practice Address - Street 1:46 FISHHOOK LN
Practice Address - Street 2:
Practice Address - City:HEDGESVILLE
Practice Address - State:WV
Practice Address - Zip Code:25427-6575
Practice Address - Country:US
Practice Address - Phone:304-754-9720
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-23
Last Update Date:2007-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YP1600X
DCPRC1271101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral