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General NPI Number Information
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NPI Number | 1881616852
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Entity Type | Individual
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Provider Name | WYNDY LEIGH MARTHINUSSEN LCSW
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Gender | Female
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Dates
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Enumeration Date | 07/25/2006
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Last Update Date | 06/02/2021
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Provider Practice Location Address
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Address Line | 282 CHOPTANK RD STE 105
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City | STAFFORD
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State | VA
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Zip | 22556-6481
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Country | US
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Telephone | 540-628-4145
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Fax |
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Provider Business Mailing Address
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Address Line | 10961 WILD GINGER CIR APT 401
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City | MANASSAS
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State | VA
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Zip | 20109-8287
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Country | US
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Telephone | 727-560-2787
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | SW8338
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License Number State | FL
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