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General NPI Number Information
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NPI Number | 1922543743
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Entity Type | Organization
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Legal Business Name | STELLA MARIS COUNSELING AND WELLNESS, LLC
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Dates
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Enumeration Date | 01/03/2017
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Last Update Date | 01/03/2017
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Provider Practice Location Address
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Address Line | 1 COLUMBUS CTR STE 665
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City | VIRGINIA BEACH
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State | VA
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Zip | 23462-6722
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Country | US
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Telephone | 757-333-7523
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Fax |
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Provider Business Mailing Address
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Address Line | 1 COLUMBUS CTR STE 665
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City | VIRGINIA BEACH
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State | VA
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Zip | 23462-6722
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MEMBER
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Name | SUSAN ELIZABETH MELNYK
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Credential | M.S., ED.S., LPC
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Telephone | 757-333-7523
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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