Provider Demographics
NPI:1063255537
Name:AUTHENTIC SELF COMPLETE WELLNESS PLLC
Entity type:Organization
Organization Name:AUTHENTIC SELF COMPLETE WELLNESS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CAREY
Authorized Official - Middle Name:
Authorized Official - Last Name:DEAN
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:540-324-3435
Mailing Address - Street 1:8263 SANGERSVILLE RD
Mailing Address - Street 2:
Mailing Address - City:BRIDGEWATER
Mailing Address - State:VA
Mailing Address - Zip Code:22812-3209
Mailing Address - Country:US
Mailing Address - Phone:540-810-5984
Mailing Address - Fax:
Practice Address - Street 1:1012 RESERVOIR ST STE A
Practice Address - Street 2:
Practice Address - City:HARRISONBURG
Practice Address - State:VA
Practice Address - Zip Code:22801-4457
Practice Address - Country:US
Practice Address - Phone:540-324-3435
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-13
Last Update Date:2025-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty