MEDICARE: KULTURA WELLNESS AND CONSULTING LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1366220261
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KULTURA WELLNESS AND CONSULTING LLC

Provider Business Mailing Address
First Line	:	9626 WORTH ST UNIT B
Second Line	:
City	:	NORFOLK
State	:	VA
Zip	:	23503-1320
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5173 EAGLE RUN RD
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23464-7869
Country	:	US
Telephone Number	:	757-332-2122
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. MELODY AGBISIT
Credential	:	PHD, LPC
Telephone Number	:	757-332-2122

Provider Enumeration Date	:	09/20/2023
Last Update Date	:	09/20/2023

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