Provider Demographics
NPI:1962855643
Name:WENDELL, DANE (LPC)
Entity Type:Individual
Prefix:MR
First Name:DANE
Middle Name:
Last Name:WENDELL
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4808 COURTHOUSE ST STE 207A
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23188-2684
Mailing Address - Country:US
Mailing Address - Phone:757-870-5203
Mailing Address - Fax:
Practice Address - Street 1:4808 COURTHOUSE ST STE 207A
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23188-2684
Practice Address - Country:US
Practice Address - Phone:757-870-5203
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-19
Last Update Date:2020-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC5865101YM0800X
VA0701008915101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health