Provider Demographics
NPI:1689042780
Name:WISHING WELL COUNSELING CENTER, PLLC
Entity type:Organization
Organization Name:WISHING WELL COUNSELING CENTER, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:MANSHEREES
Authorized Official - Middle Name:LEANN
Authorized Official - Last Name:WARD
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:757-309-1510
Mailing Address - Street 1:707 GITTINGS ST
Mailing Address - Street 2:SUITE 120
Mailing Address - City:SUFFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23434-6101
Mailing Address - Country:US
Mailing Address - Phone:757-514-3428
Mailing Address - Fax:757-514-3428
Practice Address - Street 1:707 GITTINGS ST
Practice Address - Street 2:SUITE 120
Practice Address - City:SUFFOLK
Practice Address - State:VA
Practice Address - Zip Code:23434-6101
Practice Address - Country:US
Practice Address - Phone:757-514-3428
Practice Address - Fax:757-514-3428
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-04
Last Update Date:2022-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701005261101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty