Organization
HOLISTIC LONGEVITY CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JAMIE BULLARD CPT, BCS, FNS (OWNER/NUTRITIONIST)
(703) 987-7444
Entity
Organization
Contact information
Practice address
14017 TELEGRAPH RD, WOODBRIDGE, VA 22192-4611
(703) 987-7444
Mailing address
6111 OAKLAWN LN, WOODBRIDGE, VA 22193-3969
(703) 987-7444
Taxonomy
Speciality
Code
Description
License number
State
133N00000X
Nutritionist
Primary
—
—
Other
Enumeration date
03/23/2026
Last updated
03/23/2026
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