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General NPI Number Information
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NPI Number | 1649859612
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Entity Type | Organization
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Legal Business Name | WELLNESS THERAPEUTIC SERVICES LLC
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Dates
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Enumeration Date | 04/06/2021
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Last Update Date | 04/06/2021
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Provider Practice Location Address
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Address Line | 1419 TREE RIDGE RD
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City | HENRICO
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State | VA
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Zip | 23231-6885
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Country | US
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Telephone | 804-938-5522
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Fax |
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Provider Business Mailing Address
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Address Line | 1419 TREE RIDGE RD
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City | HENRICO
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State | VA
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Zip | 23231-6885
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Country | US
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Telephone | 804-938-5522
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Fax |
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Authorized Official
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Title or Position | MANAGER/DIRECTOR
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Name | DENNIS BENGU
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Credential | LPC-R
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Telephone | 804-938-5522
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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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