Provider Demographics
NPI:1689276966
Name:WENTLAND, CHARLENE HEARNE (BCBA, LBA, PBIS-F)
Entity Type:Individual
Prefix:MS
First Name:CHARLENE
Middle Name:HEARNE
Last Name:WENTLAND
Suffix:
Gender:F
Credentials:BCBA, LBA, PBIS-F
Other - Prefix:MISS
Other - First Name:CHARLENE
Other - Middle Name:SUSAN
Other - Last Name:HEARNE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:424 ZELKOVA ROAD
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23185
Mailing Address - Country:US
Mailing Address - Phone:757-817-7125
Mailing Address - Fax:
Practice Address - Street 1:2019 CUNNINGHAM DRIVE
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23666
Practice Address - Country:US
Practice Address - Phone:757-788-8033
Practice Address - Fax:757-788-8636
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-12
Last Update Date:2020-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1-14-17599103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst