Healthcare Provider Details

I. General information

NPI: 1518645894
Provider Name (Legal Business Name): BEWELL THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2023
Last Update Date: 01/29/2024
Certification Date: 01/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 N UNION ST
ALEXANDRIA VA
22314-2642
US

IV. Provider business mailing address

201 N UNION ST STE 110
ALEXANDRIA VA
22314-2663
US

V. Phone/Fax

Practice location:
  • Phone: 703-544-9171
  • Fax: 571-933-9130
Mailing address:
  • Phone: 703-544-9171
  • Fax: 571-933-9130

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: MAUREEN AMOS
Title or Position: ADMINISTRATOR
Credential: LPC
Phone: 703-544-9171