Organization
BODY SOUL WELL
Active
Organization
BODY SOUL WELL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LEA LARAE (HOLISTIC HEALTH PRACTITIONER)
(760) 530-8073
Entity
Organization
Contact information
Practice address
30335 STONEWALL DR, LOCUST GROVE, VA 22508-9617
(760) 530-8073
Mailing address
30335 STONEWALL DR, LOCUST GROVE, VA 22508-9617
Taxonomy
Speciality
Code
Description
License number
State
171400000X
Health & Wellness Coach
—
—
174H00000X
Health Educator
Primary
—
—
2255A2300X
Athletic Trainer
—
—
Other
Enumeration date
01/29/2024
Last updated
01/29/2024
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