Healthcare Provider Details

I. General information

NPI: 1194434472
Provider Name (Legal Business Name): WRHOUSTON LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/16/2022
Last Update Date: 11/16/2022
Certification Date: 11/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1744 ATOGA AVE
MC LEAN VA
22101-4201
US

IV. Provider business mailing address

6841 ELM ST UNIT 574
MC LEAN VA
22101-8021
US

V. Phone/Fax

Practice location:
  • Phone: 973-723-2837
  • Fax:
Mailing address:
  • Phone: 973-723-2837
  • 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: WHITNEY REIGEL HOUSTON
Title or Position: OWNER, PROVIDER
Credential: LPC
Phone: 973-723-2837