Provider Demographics
NPI:1225709413
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:CEO
Authorized Official - Prefix:
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:NELSON
Authorized Official - Last Name:BAKER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:703-466-5150
Mailing Address - Street 1:6340 CENTER DR STE 100
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23502-0008
Mailing Address - Country:US
Mailing Address - Phone:800-863-7224
Mailing Address - Fax:703-649-3557
Practice Address - Street 1:6340 CENTER DR STE 100
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23502-0008
Practice Address - Country:US
Practice Address - Phone:800-863-7224
Practice Address - Fax:703-649-3557
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PROSPERITY EATING DISORDER AND WELLNESS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-09-27
Last Update Date:2021-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health