Provider Demographics
NPI:1912354309
Name:PROGRESSIVE WELLNESS COUNSELING CENTER
Entity Type:Organization
Organization Name:PROGRESSIVE WELLNESS COUNSELING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:S.
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-224-8033
Mailing Address - Street 1:PO BOX 7099
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:VA
Mailing Address - Zip Code:23666-0099
Mailing Address - Country:US
Mailing Address - Phone:757-224-8033
Mailing Address - Fax:
Practice Address - Street 1:25 HOLLIS WOOD DR
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23666-5648
Practice Address - Country:US
Practice Address - Phone:757-224-8033
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-16
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health