Healthcare Provider Details

I. General information

NPI: 1699251819
Provider Name (Legal Business Name): MERAKI WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2018
Last Update Date: 07/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8987 COTSWOLD DR
BURKE VA
22015
US

IV. Provider business mailing address

8987 COTSWOLD DR
BURKE VA
22015-1601
US

V. Phone/Fax

Practice location:
  • Phone: 202-250-0287
  • Fax:
Mailing address:
  • Phone: 202-250-0287
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER HOWARD
Title or Position: OWNER
Credential: LPC
Phone: 703-260-6320