Healthcare Provider Details

I. General information

NPI: 1033958921
Provider Name (Legal Business Name): JOEY ANNE ROQUE WAKSMUNSKI LMSW, NBC-HWC
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2024
Last Update Date: 05/21/2024
Certification Date: 05/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 BROAD ROCK BLVD
RICHMOND VA
23249-0001
US

IV. Provider business mailing address

1201 BROAD ROCK BLVD
RICHMOND VA
23249-0001
US

V. Phone/Fax

Practice location:
  • Phone: 844-618-7546
  • Fax:
Mailing address:
  • Phone: 804-637-0986
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number0903003964
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License NumberA-3922944
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: