Provider Demographics
NPI:1346025772
Name:JIVA WELLNESS
Entity Type:Organization
Organization Name:JIVA WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHANDNI
Authorized Official - Middle Name:
Authorized Official - Last Name:BHATIA
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:240-801-6202
Mailing Address - Street 1:4439 FAIR STONE DR APT 202
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22033-5118
Mailing Address - Country:US
Mailing Address - Phone:240-801-6202
Mailing Address - Fax:
Practice Address - Street 1:4439 FAIR STONE DR APT 202
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22033-5118
Practice Address - Country:US
Practice Address - Phone:240-801-6202
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-24
Last Update Date:2023-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health