Individual
BRENDA WYATT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CSAC
Contact information
Practice address
3300 GALLOWS RD, CATS AT FFX HOSPTIAL, FALLS CHURCH, VA 22042-3307
(703) 289-7573
(703) 776-7799
Mailing address
14489 WHISPERWOOD CT, DUMFRIES, VA 22025-1133
(703) 835-6360
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
710102183
VA
Other
Enumeration date
10/15/2012
Last updated
10/15/2012
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