Provider Demographics
NPI:1861411803
Name:WYNN, JUNE BOBRIN (LCSW)
Entity type:Individual
Prefix:MRS
First Name:JUNE
Middle Name:BOBRIN
Last Name:WYNN
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 1:17606 MAIN ST
Mailing Address - Street 2:SUITE 204
Mailing Address - City:DUMFRIES
Mailing Address - State:VA
Mailing Address - Zip Code:22026-2343
Mailing Address - Country:US
Mailing Address - Phone:703-221-1481
Mailing Address - Fax:
Practice Address - Street 1:17606 MAIN ST
Practice Address - Street 2:SUITE 204
Practice Address - City:DUMFRIES
Practice Address - State:VA
Practice Address - Zip Code:22026-2343
Practice Address - Country:US
Practice Address - Phone:703-221-1481
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2008-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040014551041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VACO4097Medicare Oscar/Certification