MEDICARE: WISHBONE COUNSELING, 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	101Y00000X	Counselor

General Provider Information

NPI Number	:	1891620829
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WISHBONE COUNSELING, LLC

Provider Business Mailing Address
First Line	:	9994 SOWDER VILLAGE SQ # 546
Second Line	:
City	:	MANASSAS
State	:	VA
Zip	:	20109-5464
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	10057 MOXLEYS FORD LANE
Second Line	:
City	:	BRISTOW
State	:	VA
Zip	:	20136
Country	:	US
Telephone Number	:	571-259-9573
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	LINDSAY HANNER
Credential	:	LPC
Telephone Number	:	571-259-9573

Provider Enumeration Date	:	06/12/2026
Last Update Date	:	06/12/2026

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