Organization
DEEP WELL COLLECTIVE
Active
Organization
DEEP WELL COLLECTIVE
Active
Other names
Deep Well Collective
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RYAN D HALL DCN, CNS, LDN (CEO)
(434) 326-8635
Entity
Organization
Contact information
Practice address
2071 AFTON MOUNTAIN RD, AFTON, VA 22920-2308
(434) 326-8635
Mailing address
2071 AFTON MOUNTAIN RD, AFTON, VA 22920-2308
(434) 326-8635
Taxonomy
Speciality
Code
Description
License number
State
133N00000X
Nutritionist
Primary
—
—
133NN1002X
Nutrition Education Nutritionist
—
—
133V00000X
Registered Dietitian
—
—
133VN1006X
Metabolic Nutrition Registered Dietitian
—
—
133VN1201X
Obesity and Weight Management Nutrition Registered Dietitian
—
—
133VN1301X
Oncology Nutrition Registered Dietitian
—
—
133VN1501X
Sports Dietetics Nutrition Registered Dietitian
—
—
Other
Enumeration date
07/19/2024
Last updated
07/19/2024
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