Healthcare Provider Details

I. General information

NPI: 1851779276
Provider Name (Legal Business Name): VIRGINIA BEACH COUNSELING AND WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2015
Last Update Date: 05/18/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1561 BRADFORD RD STE 104
VIRGINIA BEACH VA
23455-4089
US

IV. Provider business mailing address

1561 BRADFORD RD STE 104
VIRGINIA BEACH VA
23455-4089
US

V. Phone/Fax

Practice location:
  • Phone: 757-409-7172
  • Fax:
Mailing address:
  • Phone: 757-409-7172
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0701005771
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0904008066
License Number StateVA

VIII. Authorized Official

Name: MS. NATALIE WINGFIELD
Title or Position: DIRECTOR
Credential: LPC
Phone: 757-409-7172