Individual
DR. WANNA PROMMART
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PSYD
Contact information
Practice address
205 S WHITING ST, SUITE 601, ALEXANDRIA, VA 22304-2227
(571) 722-8872
(703) 212-8407
Mailing address
491 NAYLOR PL, ALEXANDRIA, VA 22304-2227
(571) 722-8872
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
0810003512
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
027984
VMC BEHAVIOR HEALTH SERVI
—
01
—
11551672
ACQH
—
01
—
199902
ANTHEM BLUE CROSS BLUE SH
—
01
—
3403124
CIGNA
—
01
—
361274
MHN
—
01
—
3769
CAREFIRST BLUE CROSS BLUE
—
Enumeration date
03/13/2007
Last updated
07/08/2007
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