Healthcare Provider Details

I. General information

NPI: 1043446594
Provider Name (Legal Business Name): NADINE WYKLE LPC; CSAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2009
Last Update Date: 06/10/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

311 S MONROE AVE
COVINGTON VA
24426-1635
US

IV. Provider business mailing address

311 S MONROE AVE
COVINGTON VA
24426-1635
US

V. Phone/Fax

Practice location:
  • Phone: 540-965-2100
  • Fax:
Mailing address:
  • Phone: 540-965-2100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0701004573
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number929
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: