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General NPI Number Information
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NPI Number | 1386335727
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Entity Type | Organization
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Legal Business Name | ADDICTION WELLNESS CENTER VA
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Dates
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Enumeration Date | 05/17/2023
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Last Update Date | 02/28/2025
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Provider Practice Location Address
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Address Line | 6791 JAMES MADISON HWY
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City | WARRENTON
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State | VA
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Zip | 20187-9534
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Country | US
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Telephone | 667-367-8357
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Fax |
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Provider Business Mailing Address
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Address Line | 1100 BUSINESS PKWY S STE 1
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City | WESTMINSTER
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State | MD
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Zip | 21157-3048
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CREDENTIALING SPECIALIST
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Name | JESSIE COSTLEY
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Credential |
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Telephone | 443-839-6928
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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