Healthcare Provider Details

I. General information

NPI: 1689114621
Provider Name (Legal Business Name): BE WELL, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/23/2017
Last Update Date: 02/23/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

741 HUNTLY DR
CHESAPEAKE VA
23320-6650
US

IV. Provider business mailing address

741 HUNTLY DR
CHESAPEAKE VA
23320-6650
US

V. Phone/Fax

Practice location:
  • Phone: 832-886-8111
  • Fax:
Mailing address:
  • Phone: 832-886-8111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number0810005219
License Number StateVA

VIII. Authorized Official

Name: DR. JESSICA MCCLEESE
Title or Position: MANAGER
Credential: PSYD
Phone: 832-886-8111