Provider Demographics
NPI:1356967103
Name:COMPLETE WHOLE & COMPASSIONATE CARE CWC
Entity type:Organization
Organization Name:COMPLETE WHOLE & COMPASSIONATE CARE CWC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHIATRIC NURSE PRACTITIONER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARSHALL
Authorized Official - Middle Name:ROMONA
Authorized Official - Last Name:WIGFALL
Authorized Official - Suffix:
Authorized Official - Credentials:DNP
Authorized Official - Phone:804-594-6837
Mailing Address - Street 1:1700 HUGUENOT RD STE E
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23113-2397
Mailing Address - Country:US
Mailing Address - Phone:804-594-6837
Mailing Address - Fax:804-621-2248
Practice Address - Street 1:1700 HUGUENOT RD STE 2B
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23113-2397
Practice Address - Country:US
Practice Address - Phone:804-641-7816
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-17
Last Update Date:2021-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1629306139Medicaid