Healthcare Provider Details

I. General information

NPI: 1205529849
Provider Name (Legal Business Name): WHOLE VILLAGE HEALING SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/30/2023
Last Update Date: 05/30/2023
Certification Date: 05/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3235 ACADEMY AVE STE 303
PORTSMOUTH VA
23703-3200
US

IV. Provider business mailing address

PO BOX 7693
PORTSMOUTH VA
23707-0693
US

V. Phone/Fax

Practice location:
  • Phone: 833-833-0555
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code103TH0004X
TaxonomyHealth Psychologist
License Number
License Number State

VIII. Authorized Official

Name: NATASHA JONES
Title or Position: EXECUTIVE DIRECTOR
Credential: PH.D.
Phone: 833-833-0555