Provider Demographics
NPI:1063700987
Name:AFUALO, WENDI (LSW, GCM)
Entity type:Individual
Prefix:
First Name:WENDI
Middle Name:
Last Name:AFUALO
Suffix:
Gender:F
Credentials:LSW, GCM
Other - Prefix:
Other - First Name:WENDI
Other - Middle Name:
Other - Last Name:AFUALO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LSW, GCM, CG
Mailing Address - Street 1:1656 RAVANUSA DR
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89052-4071
Mailing Address - Country:US
Mailing Address - Phone:702-301-5028
Mailing Address - Fax:702-719-2395
Practice Address - Street 1:1656 RAVANUSA DR
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-4071
Practice Address - Country:US
Practice Address - Phone:702-301-5028
Practice Address - Fax:702-719-2395
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-12
Last Update Date:2011-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV2457-S104100000X, 171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No104100000XBehavioral Health & Social Service ProvidersSocial Worker