Provider Demographics
NPI:1851367064
Name:WINE, DOROTHY ANN (LCSW)
Entity Type:Individual
Prefix:MS
First Name:DOROTHY
Middle Name:ANN
Last Name:WINE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1834 CHERRI DR
Mailing Address - Street 2:
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22043-1072
Mailing Address - Country:US
Mailing Address - Phone:703-893-2139
Mailing Address - Fax:
Practice Address - Street 1:1834 CHERRI DR
Practice Address - Street 2:
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22043-1072
Practice Address - Country:US
Practice Address - Phone:703-893-2139
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040057551041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAQ07619Medicare UPIN
VA491670Medicare ID - Type Unspecified