Provider Demographics
NPI:1093054397
Name:WINDWARD OPTIMAL HEALTH, LLC
Entity Type:Organization
Organization Name:WINDWARD OPTIMAL HEALTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:RANIERO
Authorized Official - Last Name:NORRIS
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT, PHD
Authorized Official - Phone:703-665-0754
Mailing Address - Street 1:7371 ATLAS WALK WAY #114
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20155
Mailing Address - Country:US
Mailing Address - Phone:703-665-0754
Mailing Address - Fax:
Practice Address - Street 1:7371 ATLAS WALK WAY #114
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:VA
Practice Address - Zip Code:20155
Practice Address - Country:US
Practice Address - Phone:703-665-0754
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-06
Last Update Date:2020-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0717001193106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty