Provider Demographics
NPI:1619710969
Name:OMNI-WU COALITION
Entity type:Organization
Organization Name:OMNI-WU COALITION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:BRODIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-513-1673
Mailing Address - Street 1:500 WOODLAKE DR STE 105B
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23320-8923
Mailing Address - Country:US
Mailing Address - Phone:757-513-1673
Mailing Address - Fax:757-740-5166
Practice Address - Street 1:500 WOODLAKE DR STE 105B
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-8923
Practice Address - Country:US
Practice Address - Phone:757-513-1673
Practice Address - Fax:757-740-5166
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-14
Last Update Date:2025-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health