Healthcare Provider Details

I. General information

NPI: 1922868678
Provider Name (Legal Business Name): WELLNESS BLISS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2024
Last Update Date: 03/20/2024
Certification Date: 03/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

209 MADISON ST # 320B
ALEXANDRIA VA
22314-1764
US

IV. Provider business mailing address

209 MADISON ST # 320B
ALEXANDRIA VA
22314-1764
US

V. Phone/Fax

Practice location:
  • Phone: 202-717-0410
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QC1800X
TaxonomyCorporate Health Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: MICHELLE S. WILLIAMS
Title or Position: CO-FOUNDER
Credential:
Phone: 770-940-7665