Provider Demographics
NPI:1972932713
Name:WILEY, CHRISTINE YVONNE (PHD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTINE
Middle Name:YVONNE
Last Name:WILEY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:CHRISTINE
Other - Middle Name:YVONNE
Other - Last Name:WILEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD, LPC, LICSW
Mailing Address - Street 1:4119 STEEDS GRANT WAY
Mailing Address - Street 2:
Mailing Address - City:FORT WASHINGTON
Mailing Address - State:MD
Mailing Address - Zip Code:20744-1401
Mailing Address - Country:US
Mailing Address - Phone:301-404-1842
Mailing Address - Fax:301-248-4345
Practice Address - Street 1:3845 S CAPITOL ST SW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20032-1419
Practice Address - Country:US
Practice Address - Phone:202-562-4640
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-02
Last Update Date:2017-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPRC814101YP2500X
DCLC500810441041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional