Individual
REBECCA MAXINE WYATT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CADC, CCJP, CSC
Contact information
Practice address
4 S MARKET ST, PETERSBURG, VA 23803-4216
(804) 691-6144
Mailing address
4 S MARKET ST, PETERSBURG, VA 23803-4216
(804) 691-6144
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
704151
VA
Other
Enumeration date
06/07/2011
Last updated
06/07/2011
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