Provider Demographics
NPI:1528871274
Name:WOLFE, ALEGRA GRACE (LAC)
Entity type:Individual
Prefix:
First Name:ALEGRA
Middle Name:GRACE
Last Name:WOLFE
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1493 CHAIN BRIDGE RD STE 202
Mailing Address - Street 2:
Mailing Address - City:MC LEAN
Mailing Address - State:VA
Mailing Address - Zip Code:22101-5736
Mailing Address - Country:US
Mailing Address - Phone:571-332-9860
Mailing Address - Fax:
Practice Address - Street 1:1493 CHAIN BRIDGE RD STE 202
Practice Address - Street 2:
Practice Address - City:MC LEAN
Practice Address - State:VA
Practice Address - Zip Code:22101-5736
Practice Address - Country:US
Practice Address - Phone:571-332-9860
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-28
Last Update Date:2025-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0121001182171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist