Healthcare Provider Details

I. General information

NPI: 1255206793
Provider Name (Legal Business Name): HAYWARD WELLNESS CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2025
Last Update Date: 10/06/2025
Certification Date: 10/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8000 WESTPARK DR STE 450 STE 450 PMB 1044
MC LEAN VA
22102-3100
US

IV. Provider business mailing address

8000 WESTPARK DRIVE STE 450 PMB 1044
MCLEAN VA
22102
US

V. Phone/Fax

Practice location:
  • Phone: 571-279-8981
  • Fax:
Mailing address:
  • Phone: 571-279-8981
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: DA'SHUNNDA HAYWARD-WHITE
Title or Position: CEO
Credential: LICSW
Phone: 571-279-8981