Provider Demographics
NPI:1811597164
Name:IVY COUNSELING AND WELLNESS LLC
Entity Type:Organization
Organization Name:IVY COUNSELING AND WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:ADONICE
Authorized Official - Middle Name:
Authorized Official - Last Name:D'ATRE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:434-260-2454
Mailing Address - Street 1:PO BOX 54
Mailing Address - Street 2:
Mailing Address - City:IVY
Mailing Address - State:VA
Mailing Address - Zip Code:22945-0054
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2 BOARS HEAD LN STE 140
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22903-4605
Practice Address - Country:US
Practice Address - Phone:434-260-2454
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-27
Last Update Date:2022-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty