Provider Demographics
NPI:1972116432
Name:WHOLISTIC ALIGNMENT THERAPEUTIC WELLNESS CENTER, LLC
Entity Type:Organization
Organization Name:WHOLISTIC ALIGNMENT THERAPEUTIC WELLNESS CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED CLINICAL SOCIAL WORKER
Authorized Official - Prefix:
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:WADDELL
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:757-714-4846
Mailing Address - Street 1:1205 BOULEVARD UNIT 1034
Mailing Address - Street 2:
Mailing Address - City:COLONIAL HEIGHTS
Mailing Address - State:VA
Mailing Address - Zip Code:23834-1279
Mailing Address - Country:US
Mailing Address - Phone:757-714-4846
Mailing Address - Fax:
Practice Address - Street 1:1205 BOULEVARD UNIT 1034
Practice Address - Street 2:
Practice Address - City:COLONIAL HEIGHTS
Practice Address - State:VA
Practice Address - Zip Code:23834-1279
Practice Address - Country:US
Practice Address - Phone:757-714-4846
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-25
Last Update Date:2023-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty