Provider Demographics
NPI:1215621974
Name:BE WELL - WELLNESS
Entity type:Organization
Organization Name:BE WELL - WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:MEGAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MACCUTCHEOON
Authorized Official - Suffix:
Authorized Official - Credentials:LPC, PMH-C
Authorized Official - Phone:703-624-4644
Mailing Address - Street 1:120 BEULAH RD NE STE 201
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22180-4745
Mailing Address - Country:US
Mailing Address - Phone:703-597-7205
Mailing Address - Fax:
Practice Address - Street 1:8245 BOONE BLVD STE 630
Practice Address - Street 2:
Practice Address - City:VIENNA
Practice Address - State:VA
Practice Address - Zip Code:22182-3894
Practice Address - Country:US
Practice Address - Phone:703-624-4644
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-06
Last Update Date:2023-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)