Provider Demographics
NPI:1619144359
Name:WAKHANALA, JOSEPH ATSIANZALE (LCPC)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:ATSIANZALE
Last Name:WAKHANALA
Suffix:
Gender:M
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8930 STANFORD BLVD
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21045
Mailing Address - Country:US
Mailing Address - Phone:301-445-2258
Mailing Address - Fax:301-445-1098
Practice Address - Street 1:7333 NEW HAMPSHIRE AVE
Practice Address - Street 2:SUITE 905
Practice Address - City:TAKOMA PARK
Practice Address - State:MD
Practice Address - Zip Code:20912-6958
Practice Address - Country:US
Practice Address - Phone:301-445-2258
Practice Address - Fax:301-445-1098
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-12
Last Update Date:2014-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC2248101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD011019100Medicaid