Healthcare Provider Details

I. General information

NPI: 1891623914
Provider Name (Legal Business Name): COMMONWEALTH PSYCHIATRY & WELLNESS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2026
Last Update Date: 05/11/2026
Certification Date: 05/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13506 E BOUNDARY RD STE A
MIDLOTHIAN VA
23112-3974
US

IV. Provider business mailing address

7377 NICKLAUS CIR
MOSELEY VA
23120-1680
US

V. Phone/Fax

Practice location:
  • Phone: 804-312-7685
  • Fax:
Mailing address:
  • Phone: 804-312-7685
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: HAILEGIORGIS TEKLEGIORGIS BIZUNEH
Title or Position: MANAGING MEMBER
Credential: PMHNP
Phone: 804-312-7685