Healthcare Provider Details

I. General information

NPI: 1750188678
Provider Name (Legal Business Name): NEURO EDUCATION WELLNESS CENTRE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/27/2025
Last Update Date: 02/27/2026
Certification Date: 02/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11710 PLAZA AMERICA DR STE 2000
RESTON VA
20190-4743
US

IV. Provider business mailing address

11720 PLAZA AMERICA DR STE 2000
RESTON VA
20190-4757
US

V. Phone/Fax

Practice location:
  • Phone: 888-720-7567
  • Fax:
Mailing address:
  • Phone: 888-720-7567
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code405300000X
TaxonomyPrevention Professional
License Number
License Number State

VIII. Authorized Official

Name: MS. LAURYN RIVERS
Title or Position: HEALTH EDUCATION SPECIALIST
Credential:
Phone: 888-720-7567