Provider Demographics
NPI:1346876620
Name:MOMENTUM BEHAVIORAL HEALTH & WELLNESS
Entity Type:Organization
Organization Name:MOMENTUM BEHAVIORAL HEALTH & WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NP, CS
Authorized Official - Prefix:MS
Authorized Official - First Name:TINA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:JUDGE
Authorized Official - Suffix:
Authorized Official - Credentials:NP, CS
Authorized Official - Phone:540-451-7511
Mailing Address - Street 1:2014 GOOSE CREEK RD STE 106B
Mailing Address - Street 2:
Mailing Address - City:WAYNESBORO
Mailing Address - State:VA
Mailing Address - Zip Code:22980-6588
Mailing Address - Country:US
Mailing Address - Phone:540-451-7511
Mailing Address - Fax:540-451-7512
Practice Address - Street 1:2014 GOOSE CREEK RD STE 106B
Practice Address - Street 2:
Practice Address - City:WAYNESBORO
Practice Address - State:VA
Practice Address - Zip Code:22980-6588
Practice Address - Country:US
Practice Address - Phone:540-451-7511
Practice Address - Fax:540-451-7512
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-18
Last Update Date:2020-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty