Provider Demographics
NPI:1194002014
Name:WHARTON, WENDY D (LPCMH)
Entity type:Individual
Prefix:MRS
First Name:WENDY
Middle Name:D
Last Name:WHARTON
Suffix:
Gender:F
Credentials:LPCMH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30297 DISCOUNT LAND RD
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:DE
Mailing Address - Zip Code:19956-3673
Mailing Address - Country:US
Mailing Address - Phone:302-542-5298
Mailing Address - Fax:
Practice Address - Street 1:1325 MOUNT HERMON RD
Practice Address - Street 2:SUITE 10-B
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21804-5259
Practice Address - Country:US
Practice Address - Phone:888-581-5433
Practice Address - Fax:410-820-4088
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-06
Last Update Date:2011-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEPC-0000371101Y00000X, 101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health