Healthcare Provider Details

I. General information

NPI: 1225833445
Provider Name (Legal Business Name): FALLUP WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2025
Last Update Date: 02/14/2025
Certification Date: 02/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1901 PENNSYLVANIA AVE NW STE 900
WASHINGTON DC
20006-3405
US

IV. Provider business mailing address

6808 RADCLIFFE DR
ALEXANDRIA VA
22307-1541
US

V. Phone/Fax

Practice location:
  • Phone: 754-225-2855
  • Fax:
Mailing address:
  • Phone: 754-232-0272
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: ANA GABRIELA PEREZ BARRIOS
Title or Position: CLINICAL DIRECTOR
Credential: MA LPC PSYA
Phone: 754-232-0272