Provider Demographics
NPI:1871682633
Name:DUNN, WAYNE ALAN (LCSW)
Entity Type:Individual
Prefix:
First Name:WAYNE
Middle Name:ALAN
Last Name:DUNN
Suffix:
Gender:M
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:PO BOX 492
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:22150-0492
Mailing Address - Country:US
Mailing Address - Phone:571-201-2737
Mailing Address - Fax:
Practice Address - Street 1:12584 DARBY BROOK CT
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22192-2485
Practice Address - Country:US
Practice Address - Phone:703-499-9889
Practice Address - Fax:703-499-9889
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040062521041C0700X
DCLC500777501041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
740224OtherNATIONAL CAPITAL PPO
7496795OtherAETNA
197631OtherANTHEM (BC/BS)
11570504OtherCAQH