Healthcare Provider Details

I. General information

NPI: 1265341341
Provider Name (Legal Business Name): VALE BEHAVIORAL HEALTH & WELLNESS SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/03/2026
Last Update Date: 09/03/2026
Certification Date: 08/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12449 PFITZNER CT
WOODBRIDGE VA
22192
US

IV. Provider business mailing address

12449 PFITZNER CT
WOODBRIDGE VA
22192-5595
US

V. Phone/Fax

Practice location:
  • Phone: 703-843-8917
  • Fax:
Mailing address:
  • Phone: 703-843-8917
  • Fax: 475-325-6225

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
# 2
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DR. EMMACULATE NDIFOR
Title or Position: CEO
Credential: DNP, PMHNP, FNP
Phone: 703-843-8917