Basic Information
| Provider Information | |||||||||
| NPI: | 1285653998 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WHETZEL | ||||||||
| FirstName: | STEFANI | ||||||||
| MiddleName: | P | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | LMFT, LPC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 102 HERITAGE WAY NE | ||||||||
| Address2: | SUITE 302 | ||||||||
| City: | LEESBURG | ||||||||
| State: | VA | ||||||||
| PostalCode: | 201764544 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7037715100 | ||||||||
| FaxNumber: | 7037770170 | ||||||||
| Practice Location | |||||||||
| Address1: | 102 HERITAGE WAY NE | ||||||||
| Address2: | SUITE 302 | ||||||||
| City: | LEESBURG | ||||||||
| State: | VA | ||||||||
| PostalCode: | 201764544 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7037715100 | ||||||||
| FaxNumber: | 7037770170 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/19/2006 | ||||||||
| LastUpdateDate: | 12/17/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | 0701003966 | VA | Y | Behavioral Health & Social Service Providers | Counselor | Professional | 106H00000X | 0717001079 | VA | N | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
ID Information
| ID | Type | State | Issuer | Description | 146542 | 01 | VA | ANTHEM | OTHER | 293860 | 01 | VA | AMERIGROUP | OTHER |