Provider Demographics
NPI:1225610165
Name:WELLCORP INC
Entity Type:Organization
Organization Name:WELLCORP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRINCIPAL OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:RICHELLE
Authorized Official - Middle Name:ARNETTE
Authorized Official - Last Name:BURNEY
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW, CSAC, CAADC
Authorized Official - Phone:757-332-1065
Mailing Address - Street 1:4138 SEAFARER AVE
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23518-3584
Mailing Address - Country:US
Mailing Address - Phone:757-332-1065
Mailing Address - Fax:
Practice Address - Street 1:10306 EATON PL
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-2201
Practice Address - Country:US
Practice Address - Phone:757-332-1065
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-21
Last Update Date:2021-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty