Healthcare Provider Details

I. General information

NPI: 1891620829
Provider Name (Legal Business Name): WISHBONE COUNSELING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/12/2026
Last Update Date: 06/12/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10057 MOXLEYS FORD LANE
BRISTOW VA
20136
US

IV. Provider business mailing address

9994 SOWDER VILLAGE SQ # 546
MANASSAS VA
20109-5464
US

V. Phone/Fax

Practice location:
  • Phone: 571-259-9573
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name: LINDSAY HANNER
Title or Position: OWNER
Credential: LPC
Phone: 571-259-9573