Provider Demographics
NPI:1841566783
Name:WHEATON, LAUREN ELIZABETH (LMFT)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:ELIZABETH
Last Name:WHEATON
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:LAUREN
Other - Middle Name:ELIZABETH
Other - Last Name:PUOPOLO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMFT
Mailing Address - Street 1:100 OLD LOVE POINT RD
Mailing Address - Street 2:
Mailing Address - City:STEVENSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21666-2364
Mailing Address - Country:US
Mailing Address - Phone:818-620-5642
Mailing Address - Fax:
Practice Address - Street 1:100 OLD LOVE POINT RD
Practice Address - Street 2:
Practice Address - City:STEVENSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21666-2364
Practice Address - Country:US
Practice Address - Phone:818-620-5642
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-26
Last Update Date:2022-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0717001497106H00000X
CAMFC93389106H00000X
MDLCM769106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist