Healthcare Provider Details

I. General information

NPI: 1992617518
Provider Name (Legal Business Name): CONSTELLATION PSYCHIATRY & WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/18/2026
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6486 MAIN ST
GLOUCESTER VA
23061-5492
US

IV. Provider business mailing address

6486 MAIN ST
GLOUCESTER VA
23061-5492
US

V. Phone/Fax

Practice location:
  • Phone: 804-352-2025
  • Fax: 804-352-6431
Mailing address:
  • Phone: 804-352-2025
  • Fax: 804-352-6431

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MS. ANNE MORRISSETTE
Title or Position: MANAGING MEMBER
Credential: PMHNP-BC
Phone: 804-352-2025