Healthcare Provider Details

I. General information

NPI: 1922896596
Provider Name (Legal Business Name): WELLNESS AND ACTION INTEGRATION, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/25/2025
Last Update Date: 04/25/2025
Certification Date: 04/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

776 CARSON CIR
GROTTOES VA
24441-2581
US

IV. Provider business mailing address

776 CARSON CIR
GROTTOES VA
24441-2581
US

V. Phone/Fax

Practice location:
  • Phone: 505-312-4145
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State

VIII. Authorized Official

Name: JACLYN MOURAS
Title or Position: FOUNDER/HEALTH AND WELLNESS SUPPORT
Credential: PSYD
Phone: 505-312-4145