Provider Demographics
NPI:1477205755
Name:WONLUE, AMELIA VOLAR (OPERATING MANAGER)
Entity Type:Individual
Prefix:
First Name:AMELIA
Middle Name:VOLAR
Last Name:WONLUE
Suffix:
Gender:F
Credentials:OPERATING MANAGER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16805 WINSTON LN
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22191-5106
Mailing Address - Country:US
Mailing Address - Phone:401-996-1016
Mailing Address - Fax:
Practice Address - Street 1:16805 WINSTON LN
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22191-5106
Practice Address - Country:US
Practice Address - Phone:401-996-1016
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-19
Last Update Date:2022-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician