MEDICARE: MS. WENDY WAHL MOORE LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101Y00000X	Counselor	LCPC 1603	MD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1316040306
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. WENDY WAHL MOORE LPC

Provider Business Mailing Address
First Line	:	7611 RANGE RD
Second Line	:
City	:	ALEXANDRIA
State	:	VA
Zip	:	22306-2425
Country	:	US
Telephone Number	:	410-703-2543
Fax Number	:

Provider Business Practice Location Address
First Line	:	2800 S SHIRLINGTON RD STE 350
Second Line	:
City	:	ARLINGTON
State	:	VA
Zip	:	22206-3617
Country	:	US
Telephone Number	:	703-379-9311
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/06/2006
Last Update Date	:	09/14/2023

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