Provider Demographics
NPI:1932765799
Name:WOLFE, ALEXANDRA L
Entity Type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:L
Last Name:WOLFE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4139 HALSTED ST
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22033-5527
Mailing Address - Country:US
Mailing Address - Phone:571-594-6000
Mailing Address - Fax:
Practice Address - Street 1:4139 HALSTED ST
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22033-5527
Practice Address - Country:US
Practice Address - Phone:571-594-6000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-16
Last Update Date:2019-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA48129314OtherKAISER