Provider Demographics
NPI:1053109694
Name:ETHEREAL TOUCH LLC
Entity type:Organization
Organization Name:ETHEREAL TOUCH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LPC
Authorized Official - Prefix:
Authorized Official - First Name:LYNESHA
Authorized Official - Middle Name:
Authorized Official - Last Name:WOMBLE
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:434-483-1081
Mailing Address - Street 1:400 S MILITARY HWY APT 1328
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23464-1886
Mailing Address - Country:US
Mailing Address - Phone:434-483-1081
Mailing Address - Fax:
Practice Address - Street 1:400 S MILITARY HWY APT 1328
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23464-1886
Practice Address - Country:US
Practice Address - Phone:434-483-1081
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
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No374J00000XNursing Service Related ProvidersDoulaGroup - Multi-Specialty