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General NPI Number Information
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NPI Number | 1962855643
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Entity Type | Individual
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Provider Name | DANE WENDELL LPC
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Gender | Male
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Dates
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Enumeration Date | 07/19/2016
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Last Update Date | 03/30/2020
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Provider Practice Location Address
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Address Line | 4808 COURTHOUSE ST STE 207A
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City | WILLIAMSBURG
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State | VA
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Zip | 23188-2684
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Country | US
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Telephone | 757-870-5203
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Fax |
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Provider Business Mailing Address
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Address Line | 4808 COURTHOUSE ST STE 207A
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City | WILLIAMSBURG
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State | VA
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Zip | 23188-2684
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Country | US
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Telephone | 757-870-5203
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | LC5865
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 0701008915
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License Number State | VA
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