Healthcare Provider Details

I. General information

NPI: 1215270467
Provider Name (Legal Business Name): WYTHE WELLBEING, EMOTIONAL AND BEHAVIORAL HEALTH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/05/2013
Last Update Date: 04/05/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 W MAIN ST SUITE B
WYTHEVILLE VA
24382-2376
US

IV. Provider business mailing address

469 SHARITZ RD
WYTHEVILLE VA
24382-4671
US

V. Phone/Fax

Practice location:
  • Phone: 276-546-8388
  • Fax: 276-546-8733
Mailing address:
  • Phone: 276-546-8388
  • Fax: 276-546-8733

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License NumberVA0904005700
License Number StateVA

VIII. Authorized Official

Name: MS. ASHLEY REY IHRIG
Title or Position: THERAPIST/ CLINICAL SOCIAL WORKER
Credential: LCSW
Phone: 276-546-8388