Provider Demographics
NPI:1255646154
Name:PETTIT, WENDY DENISE (LCSW-C)
Entity type:Individual
Prefix:MS
First Name:WENDY
Middle Name:DENISE
Last Name:PETTIT
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:NATIONAL INTREPID CENTER OF EXCELLENCE NNMC
Mailing Address - Street 2:BLDG. 51, 8901 ROCKVILLE PIKE
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20889-0001
Mailing Address - Country:US
Mailing Address - Phone:301-319-3692
Mailing Address - Fax:
Practice Address - Street 1:NATIONAL INTREPID CENTER OF EXCELLENCE NNMC
Practice Address - Street 2:BLDG. 51, 8901 ROCKVILLE PIKE
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20889-0001
Practice Address - Country:US
Practice Address - Phone:301-319-3692
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-16
Last Update Date:2010-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD111241041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical