Provider Demographics
NPI:1467206961
Name:LUMINA WELLNESS THERAPY PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:LUMINA WELLNESS THERAPY PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, PSYCHOTHERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:LINDSAY
Authorized Official - Last Name:COLE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:202-573-7103
Mailing Address - Street 1:3910 APPLEGATE CT
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22408-9639
Mailing Address - Country:US
Mailing Address - Phone:202-573-7103
Mailing Address - Fax:
Practice Address - Street 1:3910 APPLEGATE CT
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22408-9639
Practice Address - Country:US
Practice Address - Phone:202-573-7103
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-12
Last Update Date:2024-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty