Provider Demographics
NPI:1881616852
Name:MARTHINUSSEN, WYNDY LEIGH (LCSW)
Entity type:Individual
Prefix:MRS
First Name:WYNDY
Middle Name:LEIGH
Last Name:MARTHINUSSEN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:WYNDY
Other - Middle Name:LEIGH
Other - Last Name:NEIDHOLT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10961 WILD GINGER CIR APT 401
Mailing Address - Street 2:
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20109-8287
Mailing Address - Country:US
Mailing Address - Phone:727-560-2787
Mailing Address - Fax:
Practice Address - Street 1:282 CHOPTANK RD STE 105
Practice Address - Street 2:
Practice Address - City:STAFFORD
Practice Address - State:VA
Practice Address - Zip Code:22556-6481
Practice Address - Country:US
Practice Address - Phone:540-628-4145
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2021-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW83381041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical