Healthcare Provider Details

I. General information

NPI: 1043136088
Provider Name (Legal Business Name): LUNELLE PSYCHIATRY & WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2026
Last Update Date: 06/24/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10640 MCCORMICK FARM DR
MANASSAS VA
20110-6935
US

IV. Provider business mailing address

10550 LINDEN LAKE PLZ STE 300
MANASSAS VA
20109-6495
US

V. Phone/Fax

Practice location:
  • Phone: 540-514-0196
  • Fax:
Mailing address:
  • Phone: 540-514-0196
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: CHRISTINA MARIE THOMAS
Title or Position: NURSE PRACTITIONER
Credential: PMHNP
Phone: 540-514-0196