Provider Demographics
NPI:1205952371
Name:WENGER, VICTOR ALBERTO (REHABILITATION PROVI)
Entity type:Individual
Prefix:DR
First Name:VICTOR
Middle Name:ALBERTO
Last Name:WENGER
Suffix:
Gender:M
Credentials:REHABILITATION PROVI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5527 COROT CT
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22032-3828
Mailing Address - Country:US
Mailing Address - Phone:703-239-2442
Mailing Address - Fax:
Practice Address - Street 1:5527 COROT CT
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22032-3828
Practice Address - Country:US
Practice Address - Phone:703-239-2442
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-21
Last Update Date:2008-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0715005211225C00000X
DCPRC35101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225C00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Counselor
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional