Provider Demographics
NPI:1811903032
Name:WETTASINGHE, AJIT (LPC)
Entity type:Individual
Prefix:MR
First Name:AJIT
Middle Name:
Last Name:WETTASINGHE
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13134 OPAL LN
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22193-7006
Mailing Address - Country:US
Mailing Address - Phone:703-680-1906
Mailing Address - Fax:
Practice Address - Street 1:8850 RICHMOND HWY STE 202
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22309-1586
Practice Address - Country:US
Practice Address - Phone:703-704-6204
Practice Address - Fax:703-799-1053
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701003924101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional