Healthcare Provider Details

I. General information

NPI: 1649084534
Provider Name (Legal Business Name): WISE MIND COUNSELING, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/03/2025
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 N WASHINGTON HWY STE 204
ASHLAND VA
23005-1643
US

IV. Provider business mailing address

1500 LAKEVIEW PKWY
LOCUST GROVE VA
22508-5318
US

V. Phone/Fax

Practice location:
  • Phone: 571-412-1912
  • Fax:
Mailing address:
  • Phone: 571-412-1912
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: MRS. LESLIE DANA BOTTOMS
Title or Position: OWNER
Credential: LPC
Phone: 571-412-1912