Provider Demographics
NPI:1669170718
Name:WINGS OF WELLNESS MENTAL HEALTH, LLC
Entity type:Organization
Organization Name:WINGS OF WELLNESS MENTAL HEALTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:
Authorized Official - First Name:CATHERINE
Authorized Official - Middle Name:E
Authorized Official - Last Name:WASSON
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:720-900-4570
Mailing Address - Street 1:3331 CLARK CIR
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23509-1207
Mailing Address - Country:US
Mailing Address - Phone:720-900-4570
Mailing Address - Fax:
Practice Address - Street 1:3331 CLARK CIR
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23509-1207
Practice Address - Country:US
Practice Address - Phone:720-900-4570
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-17
Last Update Date:2023-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty