Healthcare Provider Details

I. General information

NPI: 1144610585
Provider Name (Legal Business Name): HEALING WINGS INTERNATIONAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2015
Last Update Date: 03/10/2023
Certification Date: 03/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9151 ESTATE THOMAS STE 104
ST THOMAS VI
00802-2711
US

IV. Provider business mailing address

615 SWANN AVE APT 129
ALEXANDRIA VA
22301-1452
US

V. Phone/Fax

Practice location:
  • Phone: 734-645-1261
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number1966
License Number StateVI
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. LESLIE-ANN WILLIAMS
Title or Position: SOLE MEMBER
Credential: M.D.
Phone: 888-502-4443