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General NPI Number Information
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NPI Number | 1225833445
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Entity Type | Organization
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Legal Business Name | FALLUP WELLNESS LLC
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Dates
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Enumeration Date | 02/13/2025
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Last Update Date | 02/14/2025
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Provider Practice Location Address
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Address Line | 1901 PENNSYLVANIA AVE NW STE 900
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City | WASHINGTON
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State | DC
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Zip | 20006-3405
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Country | US
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Telephone | 754-225-2855
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Fax |
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Provider Business Mailing Address
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Address Line | 6808 RADCLIFFE DR
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City | ALEXANDRIA
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State | VA
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Zip | 22307-1541
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Country | US
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Telephone | 754-232-0272
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Fax |
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Authorized Official
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Title or Position | CLINICAL DIRECTOR
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Name | ANA GABRIELA PEREZ BARRIOS
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Credential | MA LPC PSYA
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Telephone | 754-232-0272
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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