Provider Demographics
NPI:1003543778
Name:LITE MENTAL HEALTH AND WELLNESS CENTER PLLC
Entity Type:Organization
Organization Name:LITE MENTAL HEALTH AND WELLNESS CENTER PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AO
Authorized Official - Prefix:
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:GLORIA
Authorized Official - Last Name:HARVEY
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP
Authorized Official - Phone:757-606-0315
Mailing Address - Street 1:232 GEORGE WYTHE LN
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23188-7923
Mailing Address - Country:US
Mailing Address - Phone:757-606-0315
Mailing Address - Fax:
Practice Address - Street 1:232 GEORGE WYTHE LN
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23188-7923
Practice Address - Country:US
Practice Address - Phone:757-206-4994
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-03
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental HealthGroup - Single Specialty