Healthcare Provider Details

I. General information

NPI: 1841166865
Provider Name (Legal Business Name): ABIBI01 CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/15/2025
Last Update Date: 10/15/2025
Certification Date: 10/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1306 VINCENT PL
MC LEAN VA
22101-3614
US

IV. Provider business mailing address

34049 WELBOURNE RD
UPPERVILLE VA
20184-3121
US

V. Phone/Fax

Practice location:
  • Phone: 540-326-2468
  • Fax:
Mailing address:
  • Phone: 540-326-2468
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State

VIII. Authorized Official

Name: DR. AGNES ABIOLA AWOMOYI
Title or Position: OWNER
Credential: PHD
Phone: 540-326-2468