Healthcare Provider Details

I. General information

NPI: 1790609832
Provider Name (Legal Business Name): JUDY FIORELLO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JUDY BOWLES

II. Dates (important events)

Enumeration Date: 08/10/2026
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1318 JAMESTOWN RD STE 102
WILLIAMSBURG VA
23185-3382
US

IV. Provider business mailing address

4951 FENTON MILL RD
WILLIAMSBURG VA
23188-6923
US

V. Phone/Fax

Practice location:
  • Phone: 757-603-3642
  • Fax:
Mailing address:
  • Phone: 757-603-3642
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0701016543
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: