Provider Demographics
NPI:1750271763
Name:VIRGINIA WELLNESS COMMUNITY SERVICES LLC
Entity type:Organization
Organization Name:VIRGINIA WELLNESS COMMUNITY SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:GLENN
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:WATKINS
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:410-963-2262
Mailing Address - Street 1:13023 WESTERN LN
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28269-4971
Mailing Address - Country:US
Mailing Address - Phone:410-963-2262
Mailing Address - Fax:
Practice Address - Street 1:13023 WESTERN LN
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28269-4971
Practice Address - Country:US
Practice Address - Phone:410-963-2262
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-07-09
Last Update Date:2025-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health