Individual
RICHARD WYATT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LPC, CSOTP
Contact information
Practice address
4004 GENESEE PL STE 201, WOODBRIDGE, VA 22192-8305
(703) 596-2344
Mailing address
4004 GENESEE PL STE 201, WOODBRIDGE, VA 22192-8305
(703) 596-2344
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
0701014655
VA
101YM0800X
Mental Health Counselor
Primary
0701014655
VA
101YP2500X
Professional Counselor
0701014655
VA
Other
Enumeration date
05/01/2025
Last updated
09/11/2025
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