Healthcare Provider Details

I. General information

NPI: 1912338914
Provider Name (Legal Business Name): BALANCE BEHAVIORAL HEALTH, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/02/2013
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6500 WOODLAKE VILLAGE CIR
MIDLOTHIAN VA
23112-2200
US

IV. Provider business mailing address

6500 WOODLAKE VILLAGE CIR
MIDLOTHIAN VA
23112-2200
US

V. Phone/Fax

Practice location:
  • Phone: 804-823-5475
  • Fax:
Mailing address:
  • Phone: 804-823-5475
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. JESSY A NWUBA
Title or Position: OWNER
Credential:
Phone: 571-523-5479