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General NPI Number Information
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NPI Number | 1306296819
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Entity Type | Organization
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Legal Business Name | WELLNESS THERAPY SERVICES, LLC
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Dates
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Enumeration Date | 06/15/2016
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Last Update Date | 06/28/2023
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Provider Practice Location Address
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Address Line | 1158 PROFESSIONAL DR STE N
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City | WILLIAMSBURG
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State | VA
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Zip | 23185-6618
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Country | US
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Telephone | 540-693-0398
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Fax |
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Provider Business Mailing Address
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Address Line | 3997 CEDARWOOD LN
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City | WILLIAMSBURG
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State | VA
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Zip | 23188-8007
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Country | US
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Telephone | 540-693-0398
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Fax |
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Authorized Official
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Title or Position | LICENSED CLINICAL PSYCHOLOGIST
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Name | DR. NICOLE ANN SURETHING
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Credential | PH.D.
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Telephone | 540-693-0398
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 0810004081
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License Number State | VA
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