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General NPI Number Information
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NPI Number | 1053109694
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Entity Type | Organization
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Legal Business Name | ETHEREAL TOUCH LLC
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Dates
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Enumeration Date | 04/25/2025
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Last Update Date | 10/15/2025
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Provider Practice Location Address
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Address Line | 999 TIDEWATER DRIVE SUITE 2525
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City | NORFOLK
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State | VA
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Zip | 23510
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Country | US
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Telephone | 757-335-6176
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Fax |
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Provider Business Mailing Address
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Address Line | 1832 KEMPSVILLE RD SUITE 112 #22
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City | VIRGINIA BEACH
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State | VA
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Zip | 23464-1886
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Country | US
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Telephone | 757-335-6176
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Fax |
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Authorized Official
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Title or Position | LPC
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Name | LYNESHA WOMBLE
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Credential | LPC
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Telephone | 434-483-1081
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 374J00000X
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Taxonomy Name | Doula
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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