Provider Demographics
NPI:1922402510
Name:WELLNESS BEHAVIORAL HEALTH INC.
Entity Type:Organization
Organization Name:WELLNESS BEHAVIORAL HEALTH INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE/CLINICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:LASSITER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-228-5635
Mailing Address - Street 1:522 S INDEPENDENCE BLVD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23452-1149
Mailing Address - Country:US
Mailing Address - Phone:757-228-5635
Mailing Address - Fax:757-233-0327
Practice Address - Street 1:50 W QUEENS WAY
Practice Address - Street 2:SUITE 206
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23669-4279
Practice Address - Country:US
Practice Address - Phone:757-228-5635
Practice Address - Fax:757-233-0327
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-10
Last Update Date:2014-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2616251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health