MEDICARE: MANIFEST WELLNESS COUNSELING

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	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1669330288
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MANIFEST WELLNESS COUNSELING

Provider Business Mailing Address
First Line	:	1905 ARLINGTON ARCH DR
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23464-8706
Country	:	US
Telephone Number	:	757-276-1619
Fax Number	:	757-794-4812

Provider Business Practice Location Address
First Line	:	1905 ARLINGTON ARCH DR
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23464-8706
Country	:	US
Telephone Number	:	757-276-1619
Fax Number	:	757-794-4812

Authorized Official
Title or Position	:	OWNER
Name	:	KATHERINE ILLGEN
Credential	:	LCSW
Telephone Number	:	304-283-0816

Provider Enumeration Date	:	01/13/2026
Last Update Date	:	01/13/2026

Similar Medicare Providers

1255100020 — MYUNG KEE PARK DDS INC
Practice Location Address:

14435 MORENO BEACH DR STE 108
MORENO VALLEY, CA
92555-8706

Practice Phone: 951-247-6000
Practice Fax:

1801372586 — DR. JACLYN ALEXANDRA SMRECEK DDS
Practice Location Address:

1401 AVOCADO AVE STE 806
NEWPORT BEACH, CA
92660-8706

Practice Phone: 714-308-5687
Practice Fax: 949-759-8609

1821621038 — RAPHA COUNSELING SERVICES INC
Practice Location Address:

1244 THOMPKINS LN
VIRGINIA BEACH, VA
23464-5228

Practice Phone: 757-354-3025
Practice Fax:

1184214256 — BRITTANY SMITH PMHNP
Practice Location Address:

5265 PROVIDENCE RD
VIRGINIA BEACH, VA
23464-4206

Practice Phone: 757-467-9500
Practice Fax:

1104346857 — COI PERHASE BCBA
Practice Location Address:

900 COMMONWEALTH PL
VIRGINIA BEACH, VA
23464-4517

Practice Phone: 855-772-8847
Practice Fax:

1841602729 — ALICIA BARNES CHITANAND DO
Practice Location Address:

1300 SENTARA PARK # 3
VIRGINIA BEACH, VA
23464-5884

Practice Phone: 757-252-3050
Practice Fax:

Directions to “MANIFEST WELLNESS COUNSELING ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.