Charla Jeanine White

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

0810003345 Issued in VA

Practice address

9625 Surveyor CT
Suite 200
Manassas, VA 20110-4422

Phone

(703) 330-9933

Fax

(703) 368-8454

NPI assigned

Mar 1, 2006

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Charla Jeanine Wiggins Former name

Medicare fee-for-service enrollment

Enrolled in DC, VA2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 2

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Supportive Care of Virginia LLC

  • Clinical Psychologist
  • Colonial Heights, VA
  • NPI 1801485354
  Medicare reassignment NPD
• Walston Health Services LLC

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Alexandria, VA
  • NPI 1023460912

  DC

  Medicare reassignment NPD
• Mental Health Specialty Group PA

  • Mental Health Counselor
  • Durham, NC
  • NPI 1801472634

  VA

  Medicare reassignment NPD
• Supportive Care of Maryland LLC

  • Psychologist
  • Riverdale, MD
  • NPI 1447802616

  DC

  Medicare reassignment NPD
• Potomac Center Inc

  • Professional Counselor
  • Alexandria, VA
  • NPI 1457403099

  Clinical

  NPD (past)
• T Med Behavioral Inc

  • Clinical Psychologist
  • Fairfax, VA
  • NPI 1497719272
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1141171200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1250553600000",
    "number": "1063489862",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2997 STOCKHOLM WAY",
            "city": "WOODBRIDGE",
            "state": "VA",
            "postal_code": "221914286",
            "telephone_number": "703-680-5146"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9625 SURVEYOR CT",
            "address_2": "SUITE 200",
            "city": "MANASSAS",
            "state": "VA",
            "postal_code": "201104422",
            "telephone_number": "703-330-9933",
            "fax_number": "703-368-8454"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WHITE",
        "first_name": "CHARLA",
        "middle_name": "JEANINE",
        "name_prefix": "Dr.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-03-01",
        "last_updated": "2009-08-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "VA",
            "license": "0810003345",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0515622",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "CHARLA",
            "last_name": "WIGGINS",
            "middle_name": "JEANINE",
            "credential": "PSY.D.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Joanna Lynne Wen, O.D.
• Bonny Kaitlin Westerman, LCSW
• Cindy Whang, OTD
• Kristen Cozette Byington Whatley, M.A. CCC-SLP
• Ashley White
• Lee Anthony White, MS, CCC-SLP
• Linda Jean White, DDS
• Molly J. White, MD
• Nicole White, SLP
• Bridgett Victoria Whitehead, M.ED,LPC

• Clinical Psychologist in Manassas, VA
• Providers in Manassas, VA by specialty
• Clinical Psychologist in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 18, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.