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General NPI Number Information
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NPI Number | 1669330288
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Entity Type | Organization
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Legal Business Name | MANIFEST WELLNESS COUNSELING
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Dates
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Enumeration Date | 01/13/2026
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Last Update Date | 01/13/2026
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Provider Practice Location Address
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Address Line | 1905 ARLINGTON ARCH DR
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City | VIRGINIA BEACH
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State | VA
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Zip | 23464-8706
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Country | US
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Telephone | 757-276-1619
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Fax | 757-794-4812
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Provider Business Mailing Address
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Address Line | 1905 ARLINGTON ARCH DR
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City | VIRGINIA BEACH
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State | VA
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Zip | 23464-8706
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Country | US
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Telephone | 757-276-1619
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Fax | 757-794-4812
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Authorized Official
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Title or Position | OWNER
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Name | KATHERINE ILLGEN
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Credential | LCSW
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Telephone | 304-283-0816
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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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