| Wildvine Therapy | |
|
487 Mclaws Cir Ste 1b Williamsburg VA 23185-5672 | |
| (757) 899-4804 | |
| Not Available |
| Full Name | Wildvine Therapy |
|---|---|
| Speciality | Clinic/center - Mental Health (including Community Mental Health Center) |
| Location | 487 Mclaws Cir Ste 1b, Williamsburg, Virginia |
| Authorized Official Name and Position | Annalucia Bays (MEMBER) |
| Authorized Official Contact | 7578994804 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Wildvine Therapy 487 Mclaws Cir Ste 1b Williamsburg VA 23185-5672 Ph: (757) 899-4804 | Wildvine Therapy 487 Mclaws Cir Ste 1b Williamsburg VA 23185-5672 Ph: (757) 899-4804 |
| NPI Number | 1477165926 |
|---|---|
| Provider Enumeration Date | 08/17/2020 |
| Last Update Date | 06/22/2021 |
| Certification Date | 06/22/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1477165926 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
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