Provider Demographics
NPI:1184963894
Name:FORD, WENDY A (LPC)
Entity type:Individual
Prefix:
First Name:WENDY
Middle Name:A
Last Name:FORD
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:14150 PARKEAST CIR
Mailing Address - Street 2:SUITE 275
Mailing Address - City:CHANTILLY
Mailing Address - State:VA
Mailing Address - Zip Code:20151-2295
Mailing Address - Country:US
Mailing Address - Phone:703-449-6307
Mailing Address - Fax:703-968-4020
Practice Address - Street 1:14150 PARKEAST CIR
Practice Address - Street 2:SUITE 275
Practice Address - City:CHANTILLY
Practice Address - State:VA
Practice Address - Zip Code:20151-2295
Practice Address - Country:US
Practice Address - Phone:703-449-6307
Practice Address - Fax:703-968-4020
Is Sole Proprietor?:No
Enumeration Date:2013-02-01
Last Update Date:2013-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701004090101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional