Provider Demographics
NPI:1194196840
Name:THE VILLAGE WELLNESS CENTER
Entity type:Organization
Organization Name:THE VILLAGE WELLNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGIANNA
Authorized Official - Middle Name:M
Authorized Official - Last Name:ACHILLES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-464-7017
Mailing Address - Street 1:714 PINE ST
Mailing Address - Street 2:
Mailing Address - City:HERNDON
Mailing Address - State:VA
Mailing Address - Zip Code:20170-4660
Mailing Address - Country:US
Mailing Address - Phone:703-464-7017
Mailing Address - Fax:
Practice Address - Street 1:714 PINE ST
Practice Address - Street 2:
Practice Address - City:HERNDON
Practice Address - State:VA
Practice Address - Zip Code:20170-4660
Practice Address - Country:US
Practice Address - Phone:703-464-7017
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-07
Last Update Date:2015-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health