Provider Demographics
NPI:1215609748
Name:WELLNESS & BALANCE LLC
Entity type:Organization
Organization Name:WELLNESS & BALANCE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANGEL
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:WILLIAMS-KENT
Authorized Official - Suffix:
Authorized Official - Credentials:NP-C
Authorized Official - Phone:757-324-1312
Mailing Address - Street 1:3101 AMERICAN LEGION RD STE 12
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23321-5655
Mailing Address - Country:US
Mailing Address - Phone:757-469-1452
Mailing Address - Fax:757-956-5073
Practice Address - Street 1:3101 AMERICAN LEGION RD STE 12
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23321-5655
Practice Address - Country:US
Practice Address - Phone:757-469-1452
Practice Address - Fax:757-956-5073
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-03
Last Update Date:2022-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA=========OtherTAX ID