Provider Demographics
NPI:1245273614
Name:SABIN, WANDA FAYE (LCSW)
Entity type:Individual
Prefix:MS
First Name:WANDA
Middle Name:FAYE
Last Name:SABIN
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 1:12025 GENERAL TRIMBLES LN
Mailing Address - Street 2:
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20109-2015
Mailing Address - Country:US
Mailing Address - Phone:703-715-6049
Mailing Address - Fax:703-754-7724
Practice Address - Street 1:7230 HERITAGE VILLAGE PLAZA
Practice Address - Street 2:SUITE 102
Practice Address - City:GAINESVILLE
Practice Address - State:VA
Practice Address - Zip Code:20155
Practice Address - Country:US
Practice Address - Phone:703-715-6049
Practice Address - Fax:703-754-7724
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040057301041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAQ27465Medicare UPIN