Provider Demographics
NPI:1720290984
Name:CARRIA, WENDY (MA, NCSP)
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:
Last Name:CARRIA
Suffix:
Gender:F
Credentials:MA, NCSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5001 BUENA VISTA DR
Mailing Address - Street 2:
Mailing Address - City:DUMFRIES
Mailing Address - State:VA
Mailing Address - Zip Code:22025-3074
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:380 MAPLE AVE W
Practice Address - Street 2:SUITE 303B
Practice Address - City:VIENNA
Practice Address - State:VA
Practice Address - Zip Code:22180-5620
Practice Address - Country:US
Practice Address - Phone:703-938-5234
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0803000225103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool