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General NPI Number Information
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NPI Number | 1629731872
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Entity Type | Organization
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Legal Business Name | AGING WELL PSYCHIATRY, LLC
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Dates
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Enumeration Date | 10/14/2021
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Last Update Date | 08/25/2022
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Provider Practice Location Address
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Address Line | 1769 JAMESTOWN RD STE 110
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City | WILLIAMSBURG
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State | VA
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Zip | 23185-2310
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Country | US
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Telephone | 757-828-2375
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Fax | 757-794-4675
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Provider Business Mailing Address
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Address Line | 1769 JAMESTOWN RD STE 110
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City | WILLIAMSBURG
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State | VA
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Zip | 23185-2310
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Country | US
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Telephone | 757-828-2375
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Fax | 757-794-4675
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Authorized Official
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Title or Position | OWNER
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Name | ALISSON GILBERT
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Credential | PMHNP-BC, AGNP-C
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Telephone | 757-828-2375
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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