MEDICARE: B3 EMOTIONAL WELLNESS CENTER LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1871119149
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	B3 EMOTIONAL WELLNESS CENTER LLC

Provider Business Mailing Address
First Line	:	PO BOX 223
Second Line	:
City	:	NORGE
State	:	VA
Zip	:	23127-0223
Country	:	US
Telephone Number	:	757-524-2650
Fax Number	:	757-210-4055

Provider Business Practice Location Address
First Line	:	1769 JAMESTOWN RD STE 107
Second Line	:
City	:	WILLIAMSBURG
State	:	VA
Zip	:	23185-2310
Country	:	US
Telephone Number	:	757-524-2650
Fax Number	:	757-210-4055

Authorized Official
Title or Position	:	OWNER
Name	:	MICHELLE A HILL
Credential	:
Telephone Number	:	757-524-2650

Provider Enumeration Date	:	06/22/2020
Last Update Date	:	06/22/2020

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