NPIMap

Organization Active NPI

Wishing Well Counseling Center, PLLC

  • Mental Health Counselor
  • Suffolk, VA
National Provider Identifier
1689042780
Registry record updated Feb 1, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
License
0701005261 Issued in VA
Legal business name
WISHING WELL COUNSELING CENTER, PLLC
Practice address
707 Gittings St
Suite 120
Suffolk, VA 23434-6101
Phone
(757) 514-3428
Fax
(757) 514-3428
NPI assigned
Sep 4, 2015
Last updated
Feb 1, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 1, 2022

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

Authorized official

Name
Mansherees Leann Ward, LPCNPI 1831449818
Title
Owner/Therapist
Phone
(757) 309-1510

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X 0701005261 VA Primary

Addresses

Primary practice location

707 Gittings St
Suite 120
Suffolk, VA 23434-6101

Mailing address

707 Gittings St
Suite 120
Suffolk, VA 23434-6101
Phone (757) 514-3428

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20220303000133 VA Part B Supplier - Clinic/Group Practice 7113311424 Receives reassigned benefits from 15 practitioners
Practice locations: Chesapeake, VA; Suffolk, VA

National Provider Directory

National Provider Directory

Locations

707 Gittings St
Ste 120
Suffolk, VA 23434
Phone (757) 514-3248

Practitioners & affiliated clinicians

Practitioners 27

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 27

NPI Registry JSON

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

{
    "created_epoch": "1441324800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1643673600000",
    "number": "1689042780",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "707 GITTINGS ST",
            "address_2": "SUITE 120",
            "city": "SUFFOLK",
            "state": "VA",
            "postal_code": "234346101",
            "telephone_number": "757-514-3428",
            "fax_number": "757-514-3428"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "707 GITTINGS ST",
            "address_2": "SUITE 120",
            "city": "SUFFOLK",
            "state": "VA",
            "postal_code": "234346101",
            "telephone_number": "757-514-3428",
            "fax_number": "757-514-3428"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WISHING WELL COUNSELING CENTER, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-09-04",
        "last_updated": "2022-02-01",
        "certification_date": "2022-01-26",
        "status": "A",
        "authorized_official_last_name": "WARD",
        "authorized_official_first_name": "MANSHEREES",
        "authorized_official_middle_name": "LEANN",
        "authorized_official_title_or_position": "OWNER/THERAPIST",
        "authorized_official_telephone_number": "757-309-1510",
        "authorized_official_credential": "LPC"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "VA",
            "license": "0701005261",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Suffolk, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 1, 2022; 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.