Provider Demographics
NPI:1073048302
Name:PROSPERITY EATING DISORDER AND WELLNESS
Entity Type:Organization
Organization Name:PROSPERITY EATING DISORDER AND WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:
Authorized Official - Last Name:BAKER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:800-863-7224
Mailing Address - Street 1:1031 STERLING RD STE 203
Mailing Address - Street 2:
Mailing Address - City:HERNDON
Mailing Address - State:VA
Mailing Address - Zip Code:20170-3873
Mailing Address - Country:US
Mailing Address - Phone:703-446-5150
Mailing Address - Fax:
Practice Address - Street 1:1031 STERLING RD STE 203
Practice Address - Street 2:
Practice Address - City:HERNDON
Practice Address - State:VA
Practice Address - Zip Code:20170-3873
Practice Address - Country:US
Practice Address - Phone:703-446-5150
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PROSPERITY EATING DISORDER AND WELLNESS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-04-24
Last Update Date:2017-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty