Healthcare Provider Details

I. General information

NPI: 1477466837
Provider Name (Legal Business Name): PATHHAVEN WELLNESS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2026
Last Update Date: 09/25/2026
Certification Date: 09/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12872 HARBOR DR
WOODBRIDGE VA
22192-2921
US

IV. Provider business mailing address

12872 HARBOR DR STE 100
WOODBRIDGE VA
22192-2921
US

V. Phone/Fax

Practice location:
  • Phone: 571-725-3674
  • Fax: 571-998-5898
Mailing address:
  • Phone: 571-725-3674
  • Fax: 571-998-5898

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DR. CHANEL ZELAYA
Title or Position: FOUNDER & OWNER
Credential: DNP, FNP-BC PMHNP-BC
Phone: 571-725-3674