Provider Demographics
NPI:1922896596
Name:WELLNESS AND ACTION INTEGRATION, LLC
Entity type:Organization
Organization Name:WELLNESS AND ACTION INTEGRATION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER/HEALTH AND WELLNESS SUPPORT
Authorized Official - Prefix:
Authorized Official - First Name:JACLYN
Authorized Official - Middle Name:
Authorized Official - Last Name:MOURAS
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:505-312-4145
Mailing Address - Street 1:776 CARSON CIR
Mailing Address - Street 2:
Mailing Address - City:GROTTOES
Mailing Address - State:VA
Mailing Address - Zip Code:24441-2581
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:776 CARSON CIR
Practice Address - Street 2:
Practice Address - City:GROTTOES
Practice Address - State:VA
Practice Address - Zip Code:24441-2581
Practice Address - Country:US
Practice Address - Phone:505-312-4145
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-25
Last Update Date:2025-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171400000XOther Service ProvidersHealth & Wellness CoachGroup - Single Specialty