Provider Demographics
NPI:1477165926
Name:ANNALUCIA BAYS, LLC
Entity Type:Organization
Organization Name:ANNALUCIA BAYS, LLC
Other - Org Name:WILDVINE THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANNALUCIA
Authorized Official - Middle Name:
Authorized Official - Last Name:BAYS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, LCP
Authorized Official - Phone:757-899-4804
Mailing Address - Street 1:487 MCLAWS CIR STE 1B
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23185-5672
Mailing Address - Country:US
Mailing Address - Phone:757-899-4804
Mailing Address - Fax:
Practice Address - Street 1:487 MCLAWS CIR STE 1B
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23185-5672
Practice Address - Country:US
Practice Address - Phone:757-899-4804
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-17
Last Update Date:2021-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)