=====================================================
General NPI Number Information
=====================================================
NPI Number | 1922553379
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WENDY S. RADDING, LCSW
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/15/2016
-----------------------------------------------------
Last Update Date | 08/15/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4000 GENESEE PL SUITE 109
-----------------------------------------------------
City | WOODBRIDGE
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22192-8302
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 703-583-7504
-----------------------------------------------------
Fax | 703-583-7507
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4000 GENESEE PL SUITE 109
-----------------------------------------------------
City | WOODBRIDGE
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22192-8302
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 703-583-7504
-----------------------------------------------------
Fax | 703-583-7507
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MS. WENDY SHEILA RADDING
-----------------------------------------------------
Credential | LCSW
-----------------------------------------------------
Telephone | 703-583-7504
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 0904004650
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------