Healthcare Provider Details

I. General information

NPI: 1710040720
Provider Name (Legal Business Name): WILLIAM WENDT CENTER FOR LOSS AND HEALING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/19/2006
Last Update Date: 07/27/2020
Certification Date: 07/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4201 CONNECTICUT AVENUE NW SUITE 300
WASHINGTON DC
20008-1162
US

IV. Provider business mailing address

4201 CONNECTICUT AVENUE NW SUITE 300
WASHINGTON DC
20008-1162
US

V. Phone/Fax

Practice location:
  • Phone: 202-624-0010
  • Fax: 202-624-0062
Mailing address:
  • Phone: 202-624-0010
  • Fax: 202-624-0062

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: JERRI L ANGLIN
Title or Position: DIRECTOR OF CLINICAL SERVICES
Credential: LICSW
Phone: 202-422-8063