Healthcare Provider Details

I. General information

NPI: 1770819484
Provider Name (Legal Business Name): DEBORAH K WRINKLE L.C.S.W
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/30/2009
Last Update Date: 10/30/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9228 GEORGE WASHINGTON MEMORIAL HWY
GLOUCESTER VA
23061-4162
US

IV. Provider business mailing address

9228 GEORGE WASHINGTON MEMORIAL HWY
GLOUCESTER VA
23061-4162
US

V. Phone/Fax

Practice location:
  • Phone: 804-695-8119
  • Fax: 804-695-8122
Mailing address:
  • Phone: 804-695-8119
  • Fax: 804-695-8122

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0904007233
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: