Healthcare Provider Details

I. General information

NPI: 1992676688
Provider Name (Legal Business Name): EXQUISITE WELLNESS PATHWAYS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2025
Last Update Date: 09/15/2025
Certification Date: 09/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 WALNUT BLVD STE 5
PETERSBURG VA
23805-2101
US

IV. Provider business mailing address

21 WALNUT BLVD STE 5
PETERSBURG VA
23805-2101
US

V. Phone/Fax

Practice location:
  • Phone: 804-937-7665
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: JONITA JAMES
Title or Position: DIRECTOR
Credential:
Phone: 804-937-7665