Provider Demographics
NPI:1043613474
Name:PROSPERITY EATING DISORDER AND WELLNESS
Entity type:Organization
Organization Name:PROSPERITY EATING DISORDER AND WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:NELSON
Authorized Official - Last Name:BAKER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:703-466-5150
Mailing Address - Street 1:1897 PRESTON WHITE DR STE 300
Mailing Address - Street 2:
Mailing Address - City:RESTON
Mailing Address - State:VA
Mailing Address - Zip Code:20191-5479
Mailing Address - Country:US
Mailing Address - Phone:703-466-5150
Mailing Address - Fax:703-649-3559
Practice Address - Street 1:1897 PRESTON WHITE DR STE 300
Practice Address - Street 2:
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20191-5479
Practice Address - Country:US
Practice Address - Phone:703-466-5150
Practice Address - Fax:703-649-3599
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-30
Last Update Date:2025-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental HealthGroup - Single Specialty