Provider Demographics
NPI:1023488301
Name:WILEY, RHONDA (LPC LSATP)
Entity type:Individual
Prefix:MS
First Name:RHONDA
Middle Name:
Last Name:WILEY
Suffix:
Gender:F
Credentials:LPC LSATP
Other - Prefix:MS
Other - First Name:R.
Other - Middle Name:KIM
Other - Last Name:WILEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPC, LSATP
Mailing Address - Street 1:9480 MAIN ST # 1186
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22031-4032
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8221 WILLOW OAKS CORPORATE DR # 1-417
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-4512
Practice Address - Country:US
Practice Address - Phone:703-559-3188
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-30
Last Update Date:2024-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701006476101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional