Provider Demographics
NPI:1578896890
Name:VEREECKE, WILFRIED C
Entity Type:Individual
Prefix:
First Name:WILFRIED
Middle Name:C
Last Name:VEREECKE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4100 NEBRASKA AVE NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20016-2736
Mailing Address - Country:US
Mailing Address - Phone:202-363-1841
Mailing Address - Fax:202-363-1841
Practice Address - Street 1:4100 NEBRASKA AVE NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20016-2736
Practice Address - Country:US
Practice Address - Phone:202-363-1841
Practice Address - Fax:202-363-1841
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-18
Last Update Date:2009-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPRC14002101YP2500X
DCADVANCED CANDIDATE102L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst