Provider Demographics
NPI:1609886241
Name:WENZEL, CHARLOTTE KATHARINA (PH D)
Entity type:Individual
Prefix:DR
First Name:CHARLOTTE
Middle Name:KATHARINA
Last Name:WENZEL
Suffix:
Gender:F
Credentials:PH D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3108 NORTH PARHAM RD
Mailing Address - Street 2:STE 200 A
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23294
Mailing Address - Country:US
Mailing Address - Phone:804-273-9687
Mailing Address - Fax:804-290-0474
Practice Address - Street 1:3108 NORTH PARHAM RD
Practice Address - Street 2:STE 200 A
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23294
Practice Address - Country:US
Practice Address - Phone:804-273-9687
Practice Address - Fax:804-290-0474
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810001243103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA7750978Medicaid
VA1310196OtherHIPAA
R62101Medicare UPIN
VA7750978Medicaid