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General NPI Number Information
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NPI Number | 1518645894
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Entity Type | Organization
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Legal Business Name | BEWELL THERAPY LLC
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Dates
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Enumeration Date | 07/07/2023
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Last Update Date | 01/29/2024
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Provider Practice Location Address
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Address Line | 201 N UNION ST
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City | ALEXANDRIA
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State | VA
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Zip | 22314-2642
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Country | US
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Telephone | 703-544-9171
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Fax | 571-933-9130
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Provider Business Mailing Address
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Address Line | 201 N UNION ST STE 110
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City | ALEXANDRIA
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State | VA
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Zip | 22314-2663
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Country | US
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Telephone | 703-544-9171
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Fax | 571-933-9130
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MAUREEN AMOS
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Credential | LPC
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Telephone | 703-544-9171
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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