Provider Demographics
NPI:1629807441
Name:BESPOKEN WELLNESS PLLC
Entity type:Organization
Organization Name:BESPOKEN WELLNESS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SENIOR BUSINESS CONSULTANT
Authorized Official - Prefix:
Authorized Official - First Name:NAOMI
Authorized Official - Middle Name:
Authorized Official - Last Name:WADDY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-947-0382
Mailing Address - Street 1:PO BOX 74381
Mailing Address - Street 2:
Mailing Address - City:NORTH CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23236-0007
Mailing Address - Country:US
Mailing Address - Phone:703-947-0382
Mailing Address - Fax:
Practice Address - Street 1:1010 E PARKERVILLE RD
Practice Address - Street 2:
Practice Address - City:CEDAR HILL
Practice Address - State:TX
Practice Address - Zip Code:75104-7100
Practice Address - Country:US
Practice Address - Phone:469-806-0857
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-30
Last Update Date:2024-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty