Healthcare Provider Details

I. General information

NPI: 1396684494
Provider Name (Legal Business Name): WAYNE FREDERICK HANDLEY PH.D., LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/25/2026
Last Update Date: 03/25/2026
Certification Date: 03/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 RUNNING CEDAR LN
FAIRFIELD VA
24435-2651
US

IV. Provider business mailing address

55 RUNNING CEDAR LN
FAIRFIELD VA
24435-2651
US

V. Phone/Fax

Practice location:
  • Phone: 757-708-8342
  • Fax: 757-708-8342
Mailing address:
  • Phone: 757-708-8342
  • Fax: 757-708-8342

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0701015047
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: