Provider Demographics
NPI:1194453381
Name:GWEAMA, NANWHER WEAHMAR
Entity type:Individual
Prefix:
First Name:NANWHER
Middle Name:WEAHMAR
Last Name:GWEAMA
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 1:80 ROCK RAYMOND DR
Mailing Address - Street 2:
Mailing Address - City:STAFFORD
Mailing Address - State:VA
Mailing Address - Zip Code:22554-3368
Mailing Address - Country:US
Mailing Address - Phone:240-386-9324
Mailing Address - Fax:
Practice Address - Street 1:80 ROCK RAYMOND DR
Practice Address - Street 2:
Practice Address - City:STAFFORD
Practice Address - State:VA
Practice Address - Zip Code:22554-3368
Practice Address - Country:US
Practice Address - Phone:240-386-9324
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-15
Last Update Date:2022-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0903003291104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker