Provider Demographics
NPI:1538822275
Name:FOUTS, WENDY ANN (LGPC)
Entity type:Individual
Prefix:MRS
First Name:WENDY
Middle Name:ANN
Last Name:FOUTS
Suffix:
Gender:F
Credentials:LGPC
Other - Prefix:
Other - First Name:WENDY
Other - Middle Name:ANN
Other - Last Name:FOUT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8894 STANFORD BLVD
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21045-4794
Mailing Address - Country:US
Mailing Address - Phone:443-241-6644
Mailing Address - Fax:
Practice Address - Street 1:8894 STANFORD BLVD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21045-4794
Practice Address - Country:US
Practice Address - Phone:443-241-6644
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-19
Last Update Date:2021-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLGP10964101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty