Provider Demographics
NPI:1154714814
Name:WOJCIK, BREANNE
Entity type:Individual
Prefix:
First Name:BREANNE
Middle Name:
Last Name:WOJCIK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6200 N KINGS HWY
Mailing Address - Street 2:APT. 107
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22303-2900
Mailing Address - Country:US
Mailing Address - Phone:202-740-3063
Mailing Address - Fax:
Practice Address - Street 1:6200 N KINGS HWY
Practice Address - Street 2:APT. 107
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22303-2900
Practice Address - Country:US
Practice Address - Phone:202-740-3063
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-05
Last Update Date:2015-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110026265EMedicaid