Provider Demographics
NPI:1265907562
Name:WIENERS, MARYRITA
Entity type:Individual
Prefix:
First Name:MARYRITA
Middle Name:
Last Name:WIENERS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:910 17TH ST NW STE 306
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20006-2604
Mailing Address - Country:US
Mailing Address - Phone:220-296-5695
Mailing Address - Fax:
Practice Address - Street 1:910 17TH ST NW STE 306
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20006-2604
Practice Address - Country:US
Practice Address - Phone:220-296-5695
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-12
Last Update Date:2018-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPRC36101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional