Healthcare Provider Details

I. General information

NPI: 1619787983
Provider Name (Legal Business Name): WILDFLOWER COUNSELING AND WELLNESS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2025
Last Update Date: 01/09/2025
Certification Date: 01/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

356 S MAIN ST
HARRISONBURG VA
22801-3628
US

IV. Provider business mailing address

356 S MAIN ST
HARRISONBURG VA
22801-3628
US

V. Phone/Fax

Practice location:
  • Phone: 540-421-0992
  • Fax:
Mailing address:
  • Phone: 540-421-0992
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: JESSICA SIBOLD ASHBY
Title or Position: COUNSELOR
Credential: LPC
Phone: 540-421-0992