Healthcare Provider Details

I. General information

NPI: 1255941332
Provider Name (Legal Business Name): HOLISTIC PAIN AND WELLNESS SPECIALISTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2020
Last Update Date: 04/10/2025
Certification Date: 04/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 W BROAD ST STE 302
FALLS CHURCH VA
22046-4200
US

IV. Provider business mailing address

5732 HARRIER DR
CLIFTON VA
20124-0910
US

V. Phone/Fax

Practice location:
  • Phone: 703-637-3586
  • Fax: 703-637-3586
Mailing address:
  • Phone: 703-637-3586
  • Fax: 703-637-3586

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: CHERITH JOY ZORBAS
Title or Position: OWNER
Credential:
Phone: 571-208-8164