Healthcare Provider Details

I. General information

NPI: 1932382009
Provider Name (Legal Business Name): WLF-CHAR
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2007
Last Update Date: 12/12/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1913 COMMONWEALTH DR
CHARLOTTESVILLE VA
22901-2338
US

IV. Provider business mailing address

4456 CORPORATION LN
VIRGINIA BEACH VA
23462-3151
US

V. Phone/Fax

Practice location:
  • Phone: 434-977-6777
  • Fax:
Mailing address:
  • Phone: 757-497-8899
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number2207004
License Number StateVA

VIII. Authorized Official

Name: MR. DOUGLAS LOREN HERRING
Title or Position: PARTNER
Credential:
Phone: 540-347-4292