Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YM0800X | Mental Health Counselor |
NPI | 1003264722 |
---|---|
Provider Name | Elizabeth Wyman |
First Address | Mc Lean, VA 22101-3647 |
Second Address | Mc Lean, VA 22101-3647 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/06/2016 |
Last Update Date | 05/01/2022 |