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General NPI Number Information
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NPI Number | 1568284354
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Entity Type | Organization
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Legal Business Name | SOMOS WELLNESS COUNSELING
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Dates
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Enumeration Date | 10/31/2024
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Last Update Date | 10/31/2024
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Provider Practice Location Address
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Address Line | 5809 LAKESIDE AVE STE G1C
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City | HENRICO
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State | VA
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Zip | 23228-5746
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Country | US
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Telephone | 804-877-3219
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Fax |
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Provider Business Mailing Address
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Address Line | 2415 BOYLE AVE
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City | RICHMOND
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State | VA
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Zip | 23230-2325
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Country | US
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Telephone | 804-833-0192
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MS. JENNIFER P ORTEGA
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Credential | LCSW
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Telephone | 804-877-3219
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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