NPIMap

Organization Active NPI

Seaside Wellness, LLC

Doing business as Ellie Mental Health

  • Mental Health Counselor
  • Yorktown, VA
National Provider Identifier
1255026746
Registry record updated Apr 29, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
Legal business name
SEASIDE WELLNESS, LLC
Doing business as
Ellie Mental Health
Practice address
501 Village Ave Ste 204
Yorktown, VA 23693-5657
Phone
(757) 813-7894
NPI assigned
Apr 10, 2023
Last updated
Apr 29, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 29, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Denise W Wash
Title
Owner
Phone
(757) 813-7894

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X NU Primary

Addresses

Primary practice location

501 Village Ave Ste 204
Yorktown, VA 23693-5657

Mailing address

402 Old Landing Rd
Yorktown, VA 23692-4316
Phone (757) 813-7894

Other names 1

  • Ellie Mental Health Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20240607001940 VA Part B Supplier - Clinic/Group Practice 5294277075 Receives reassigned benefits from 9 practitioners
Practice locations: North Chesterfield, VA; Williamsburg, VA; Yorktown, VA

National Provider Directory

National Provider Directory

Locations

5400 Discovery Park Blvd
Ste 201
Williamsburg, VA 23188
Phone (757) 992-9291

501 Village Ave
Ste 200
Yorktown, VA 23693
Phone (757) 568-5904

501 Village Ave
Ste 204
Yorktown, VA 23693
Phone (757) 568-5904

Practitioners & affiliated clinicians

Practitioners 26

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 26

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1681084800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1714348800000",
    "number": "1255026746",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "402 OLD LANDING RD",
            "city": "YORKTOWN",
            "state": "VA",
            "postal_code": "236924316",
            "telephone_number": "757-813-7894"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "501 VILLAGE AVE STE 204",
            "city": "YORKTOWN",
            "state": "VA",
            "postal_code": "236935657",
            "telephone_number": "757-813-7894"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SEASIDE WELLNESS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-04-10",
        "last_updated": "2024-04-29",
        "certification_date": "2024-04-29",
        "status": "A",
        "authorized_official_last_name": "WASH",
        "authorized_official_first_name": "DENISE",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "757-813-7894"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Ellie Mental Health",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Ellie Mental Health",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Yorktown, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 29, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.