Individual
MR. BRUCE CHARLES WYMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LPC, EDM, NCC
Contact information
Practice address
10391 GREYSON LN, RIXEYVILLE, VA 22737-1730
(540) 937-4923
(540) 937-7680
Mailing address
PO BOX 373, RIXEYVILLE, VA 22737-0373
(540) 937-4923
(540) 937-7680
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
0701003919
VA
101YP2500X
Professional Counselor
Primary
0701003919
VA
101YS0200X
School Counselor
0701003919
VA
106H00000X
Marriage & Family Therapist
0701003919
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
010375703
—
VA
01
—
11654016
CAQH
VA
01
—
4435897
CIGNA BEHAVIORAL
VA
01
—
AS43-0001
CAREFIRST BLUECROSS BLUESHIELD
VA
Enumeration date
08/31/2006
Last updated
03/13/2014
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