Provider Demographics
NPI:1851801377
Name:VENTRESS, WANDA FAYE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:WANDA
Middle Name:FAYE
Last Name:VENTRESS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:221 VEROT SCHOOL RD APT 437
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508-8246
Mailing Address - Country:US
Mailing Address - Phone:337-277-6611
Mailing Address - Fax:
Practice Address - Street 1:130 CHAPPUIS DR
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70501-3656
Practice Address - Country:US
Practice Address - Phone:337-277-6611
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-11
Last Update Date:2023-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA6885104100000X, 261QM0801X
101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA6885OtherLA STATE BOARD OF SOCIAL WORKERS