Provider Demographics
NPI:1326814484
Name:NOUVEAU PSYCHOLOGICAL WELLNESS, PLLC
Entity Type:Organization
Organization Name:NOUVEAU PSYCHOLOGICAL WELLNESS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PAIGE
Authorized Official - Middle Name:
Authorized Official - Last Name:VICTORINE
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:571-534-3825
Mailing Address - Street 1:1530 WILSON BLVD STE 360
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22209-2466
Mailing Address - Country:US
Mailing Address - Phone:571-534-3825
Mailing Address - Fax:571-376-6941
Practice Address - Street 1:1530 WILSON BLVD STE 360
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22209-2466
Practice Address - Country:US
Practice Address - Phone:571-534-3825
Practice Address - Fax:571-376-6941
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-30
Last Update Date:2023-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental HealthGroup - Multi-Specialty
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health