| Organization Name: | PROSPERITY EATING DISORDERS AND WELLNESS |
| NPI Number: | 1043613474 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | HEATHER NELSON BAKER (DIRECTOR) |
| Mailing Address: | 1031 Sterling Rd Suite 203 Herndon |
| State: | VA US |
| Postal Code: | 201703865 |
| Phone Number: | 7034665150 |
| Fax Number: | 7036493557 |
| NPI Enumeration Date: | 09/30/2014 |
| NPI Last Update Date: | 09/30/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1041C0700X |
| License Number: | 0904005419 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | VA |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Social Worker |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | A social worker who holds a master |