Provider Demographics
NPI:1164058111
Name:WELLNESS ARTS COUNSELING LLC
Entity Type:Organization
Organization Name:WELLNESS ARTS COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EMPLOYEE
Authorized Official - Prefix:
Authorized Official - First Name:DOROTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:540-219-9001
Mailing Address - Street 1:6121 BLANTYRE RD
Mailing Address - Street 2:
Mailing Address - City:BROAD RUN
Mailing Address - State:VA
Mailing Address - Zip Code:20137-1817
Mailing Address - Country:US
Mailing Address - Phone:540-219-9001
Mailing Address - Fax:
Practice Address - Street 1:13890 BRADDOCK RD STE 312
Practice Address - Street 2:
Practice Address - City:CENTREVILLE
Practice Address - State:VA
Practice Address - Zip Code:20121-2438
Practice Address - Country:US
Practice Address - Phone:540-219-9001
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-20
Last Update Date:2020-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty