Healthcare Provider Details

I. General information

NPI: 1316212822
Provider Name (Legal Business Name): SUSAN WENDELGEST BEST LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/16/2012
Last Update Date: 03/16/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26317 W WASHINGTON ST
PETERSBURG VA
23803-2727
US

IV. Provider business mailing address

26317 W WASHINGTON ST
PETERSBURG VA
23803-2727
US

V. Phone/Fax

Practice location:
  • Phone: 804-862-8000
  • Fax: 804-722-4291
Mailing address:
  • Phone: 804-862-8000
  • Fax: 804-722-4291

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0904005921
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: