Organization
ADDICTION WELLNESS CENTER VA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JESSIE COSTLEY (CREDENTIALING SPECIALIST)
(443) 839-6928
Entity
Organization
Contact information
Practice address
6791 JAMES MADISON HWY, WARRENTON, VA 20187-9534
(667) 367-8357
Mailing address
1100 BUSINESS PKWY S STE 1, WESTMINSTER, MD 21157-3048
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
30017626680001
—
VA
Enumeration date
05/17/2023
Last updated
02/28/2025
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