Provider Demographics
NPI:1356971022
Name:TWO RIVERS WELLNESS CENTER LLC
Entity type:Organization
Organization Name:TWO RIVERS WELLNESS CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:ROMINA
Authorized Official - Middle Name:
Authorized Official - Last Name:ABAWI-WOOTEN
Authorized Official - Suffix:
Authorized Official - Credentials:LPC, CSAC, NCC
Authorized Official - Phone:703-498-8675
Mailing Address - Street 1:1158 PROFESSIONAL DR STE K
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23185-6618
Mailing Address - Country:US
Mailing Address - Phone:703-498-8675
Mailing Address - Fax:
Practice Address - Street 1:1158 PROFESSIONAL DR STE K
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23185-6618
Practice Address - Country:US
Practice Address - Phone:703-498-8675
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-22
Last Update Date:2020-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty