Provider Demographics
NPI:1669731659
Name:WEST, WENDY ELLEN (MSW, LCSW)
Entity type:Individual
Prefix:
First Name:WENDY
Middle Name:ELLEN
Last Name:WEST
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 INLET CT
Mailing Address - Street 2:
Mailing Address - City:HERTFORD
Mailing Address - State:NC
Mailing Address - Zip Code:27944-9757
Mailing Address - Country:US
Mailing Address - Phone:252-619-4623
Mailing Address - Fax:
Practice Address - Street 1:112 INLET CT
Practice Address - Street 2:
Practice Address - City:HERTFORD
Practice Address - State:NC
Practice Address - Zip Code:27944-9757
Practice Address - Country:US
Practice Address - Phone:252-619-4623
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-10
Last Update Date:2012-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0073431041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical