| Bird On A Wire, Llc | |
|
15 Research Drive Suite A Hampton VA 23666 | |
| (804) 413-9037 | |
| (757) 852-0475 |
| Full Name | Bird On A Wire, Llc |
|---|---|
| Speciality | Marriage & Family Therapist |
| Location | 15 Research Drive, Hampton, Virginia |
| Authorized Official Name and Position | Gwendolyn Rose Mbuvi (OWNER) |
| Authorized Official Contact | 8044139037 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Bird On A Wire, Llc 5007c Victory Blvd # 177 Yorktown VA 23693-5601 Ph: (804) 413-9037 | Bird On A Wire, Llc 15 Research Drive Suite A Hampton VA 23666 Ph: (804) 413-9037 |
| NPI Number | 1760065858 |
|---|---|
| Provider Enumeration Date | 05/05/2021 |
| Last Update Date | 12/15/2023 |
| Certification Date | 12/15/2023 |
| Medicare PECOS PAC ID | 3274978135 |
|---|---|
| Medicare Enrollment ID | O20240301000113 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1760065858 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | (* (Not Available)) | Secondary |
| 106H00000X | Marriage & Family Therapist | (* (Not Available)) | Primary |
| Provider Name | Gwendolyn Rose Mbuvi |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1174131452 PECOS PAC ID: 7911306212 Enrollment ID: I20240301000227 |
| Provider Name | Natasha Hubbard |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1366033508 PECOS PAC ID: 6507205176 Enrollment ID: I20240415004122 |
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