Provider Demographics
NPI:1982612370
Name:HAUPT, WENDY HARRIS (MSW, LCSW)
Entity Type:Individual
Prefix:MRS
First Name:WENDY
Middle Name:HARRIS
Last Name:HAUPT
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 1:201 N WASHINGTON HWY STE 207
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:VA
Mailing Address - Zip Code:23005-1643
Mailing Address - Country:US
Mailing Address - Phone:804-258-3765
Mailing Address - Fax:804-299-3453
Practice Address - Street 1:201 N WASHINGTON HWY STE 207
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:VA
Practice Address - Zip Code:23005
Practice Address - Country:US
Practice Address - Phone:804-258-3765
Practice Address - Fax:804-299-3453
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-03
Last Update Date:2018-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040024161041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA8912319Medicaid