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General NPI Number Information
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NPI Number | 1558000166
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Entity Type | Organization
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Legal Business Name | WHOLISTIC WELLNESS CENTER LLC
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Dates
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Enumeration Date | 06/01/2022
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Last Update Date | 06/01/2022
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Provider Practice Location Address
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Address Line | 5680 KING CENTRE DR STE 600
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City | ALEXANDRIA
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State | VA
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Zip | 22315-5755
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Country | US
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Telephone | 703-249-9175
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Fax | 703-562-7714
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Provider Business Mailing Address
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Address Line | 5680 KING CENTRE DR STE 600
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City | ALEXANDRIA
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State | VA
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Zip | 22315-5755
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Country | US
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Telephone | 703-249-9175
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Fax | 703-562-7714
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Authorized Official
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Title or Position | OWNER
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Name | CANDANCE DORAN
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Credential |
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Telephone | 703-249-9175
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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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 | 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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Taxonomy #3
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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 #4
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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 #5
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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