Healthcare Provider Details

I. General information

NPI: 1932678265
Provider Name (Legal Business Name): WILLIAMSBURG COUNSELING AND WELLNESS CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2018
Last Update Date: 11/15/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 PROFESSIONAL DR
WILLIAMSBURG VA
23185-3301
US

IV. Provider business mailing address

1101 PROFESSIONAL DR
WILLIAMSBURG VA
23185-3301
US

V. Phone/Fax

Practice location:
  • Phone: 757-344-1701
  • Fax: 757-644-1476
Mailing address:
  • Phone: 757-344-1701
  • Fax: 757-644-1476

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: KERI WILLIS-HIGGONS
Title or Position: OWNER
Credential: LPC
Phone: 757-344-1701