Provider Demographics
NPI:1871877654
Name:WANZER, VERONICA M (LCPC)
Entity type:Individual
Prefix:DR
First Name:VERONICA
Middle Name:M
Last Name:WANZER
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:509 QUINCE ORCHARD RD # 129
Mailing Address - Street 2:
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20878-1435
Mailing Address - Country:US
Mailing Address - Phone:240-427-5547
Mailing Address - Fax:240-465-0422
Practice Address - Street 1:509 QUINCE ORCHARD RD # 129
Practice Address - Street 2:
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20878-1435
Practice Address - Country:US
Practice Address - Phone:240-427-5547
Practice Address - Fax:240-465-0422
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-28
Last Update Date:2020-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD5170OtherLICENSE NUMBER