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General NPI Number Information
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NPI Number | 1760065858
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Entity Type | Organization
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Legal Business Name | BIRD ON A WIRE, LLC
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Dates
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Enumeration Date | 05/05/2021
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Last Update Date | 12/15/2023
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Provider Practice Location Address
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Address Line | 15 RESEARCH DRIVE SUITE A
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City | HAMPTON
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State | VA
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Zip | 23666
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Country | US
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Telephone | 804-413-9037
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Fax | 757-852-0475
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Provider Business Mailing Address
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Address Line | 5007C VICTORY BLVD # 177
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City | YORKTOWN
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State | VA
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Zip | 23693-5601
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Country | US
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Telephone | 804-413-9037
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Fax | 757-852-0475
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Authorized Official
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Title or Position | OWNER
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Name | GWENDOLYN ROSE MBUVI
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Credential | LMFT
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Telephone | 804-413-9037
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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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Taxonomy #2
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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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