A Balanced Life Wellness Clinic and Apothecary, LLC

NPI #1629478037 in Reston, Virginia

Provider Information

NPI Number: 1629478037
Entity Type: Organization
Organization Name: A Balanced Life Wellness Clinic and Apothecary, LLC
Primary Specialty: Nutritionist
Enumeration Date: Sep 4, 2014
Last Updated: Sep 4, 2014

Practice Location

Address: 1818 LIBRARY ST
Address 2: STE 500
City: Reston
State: Virginia
ZIP Code: 20190-6242
Phone: (301) 602-1518

Authorized Official

Name: BETSY COSTILO
Title: PRESIDENT
Phone: (301) 602-1518

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Nutritionist	133N00000X	Primary

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