Provider Demographics
NPI:1932678265
Name:WILLIAMSBURG COUNSELING AND WELLNESS CENTER, LLC
Entity Type:Organization
Organization Name:WILLIAMSBURG COUNSELING AND WELLNESS CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KERI
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIS-HIGGONS
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:757-344-1701
Mailing Address - Street 1:1101 PROFESSIONAL DR
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23185-3301
Mailing Address - Country:US
Mailing Address - Phone:757-344-1701
Mailing Address - Fax:757-644-1476
Practice Address - Street 1:1101 PROFESSIONAL DR
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23185-3301
Practice Address - Country:US
Practice Address - Phone:757-344-1701
Practice Address - Fax:757-644-1476
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-15
Last Update Date:2018-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)