# BODHI WELLNESS LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1285426718
- **Authorized official:** SHANNON COULSON NP (OWNER)
- **Authorized official phone:** (757) 239-5858

## Contact information

- **Practice address:** 1832 KENPSVILLE RD STE 112, LA BREAK, VA 23116
- **Practice address phone:** (757) 239-5858
- **Mailing address:** 1832 KENPSVILLE RD STE 112, LA BREAK, VA 23116
- **Mailing address phone:** (757) 239-5858

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363L00000X | Nurse Practitioner | — | NULL | Yes |
| 363L00000X | Nurse Practitioner | — | — | Yes |

## Other

- **Enumeration date:** 05/20/2025
- **Last updated:** 05/20/2025