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General NPI Number Information
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NPI Number | 1992239693
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Entity Type | Organization
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Legal Business Name | SPREAD YOUR WINGS
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Dates
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Enumeration Date | 04/19/2017
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Last Update Date | 11/20/2024
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Provider Practice Location Address
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Address Line | 2430 SOUTHLAND DRIVE
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City | CHESTER
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State | VA
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Zip | 23831-2354
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Country | US
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Telephone | 804-528-4331
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Fax | 804-222-3232
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Provider Business Mailing Address
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Address Line | 2430 SOUTHLAND DRIVE
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City | CHESTER
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State | VA
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Zip | 23831-2354
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Country | US
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Telephone | 804-528-4331
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Fax | 804-222-3232
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Authorized Official
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Title or Position | OWNER/CEO
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Name | PIPPI M WINGFIELD
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Credential | MSW, LCSW
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Telephone | 804-350-5336
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State | VA
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