Provider Demographics
NPI:1659466076
Name:HALL, WENDY GAIL (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:GAIL
Last Name:HALL
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:WENDY
Other - Middle Name:GAIL
Other - Last Name:HALL-WOOD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW, LCSW
Mailing Address - Street 1:7459 OLD HICKORY DR
Mailing Address - Street 2:
Mailing Address - City:MECHANICSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:23111-3631
Mailing Address - Country:US
Mailing Address - Phone:804-730-2052
Mailing Address - Fax:804-730-1511
Practice Address - Street 1:7459 OLD HICKORY DR
Practice Address - Street 2:
Practice Address - City:MECHANICSVILLE
Practice Address - State:VA
Practice Address - Zip Code:23111-3631
Practice Address - Country:US
Practice Address - Phone:804-644-9590
Practice Address - Fax:804-649-2151
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2019-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040059411041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA004945182Medicaid