Provider Demographics
NPI:1447009964
Name:CDEBACA-WHITE, WENDY RENEE (LPC)
Entity type:Individual
Prefix:
First Name:WENDY
Middle Name:RENEE
Last Name:CDEBACA-WHITE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23054 SULLIVANS COVE SQ
Mailing Address - Street 2:
Mailing Address - City:BRAMBLETON
Mailing Address - State:VA
Mailing Address - Zip Code:20148-4954
Mailing Address - Country:US
Mailing Address - Phone:321-432-7229
Mailing Address - Fax:
Practice Address - Street 1:9687 MAIN ST STE D
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-3753
Practice Address - Country:US
Practice Address - Phone:703-303-8832
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-16
Last Update Date:2024-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701013057101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional