Organization
PROSPERITY EATING DISORDER AND WELLNESS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
HEATHER BAKER LCSW (DIRECTOR)
(434) 326-4577
Entity
Organization
Contact information
Practice address
709 W MAIN ST, CHARLOTTESVILLE, VA 22903-4570
(434) 326-4577
Mailing address
1031 STERLING RD STE 203, HERNDON, VA 20170-3873
(703) 446-5150
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
—
—
261QM0850X
Adult Mental Health Clinic/Center
—
—
261QM0855X
Adolescent and Children Mental Health Clinic/Center
—
—
Other
Enumeration date
06/01/2016
Last updated
06/01/2016
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