OrganizationActive
A Balanced Life Wellness Clinic and Apothecary, LLC
NPI 1629478037 · Nutritionist · Reston, VA
Provider details
- NPI number
- 1629478037
- Entity type
- Organization
- Primary specialty
- NutritionistDietary & Nutritional Service Providers
- Authorized official
- Betsy Costilo, President
Mailing address
1818 Library St
Reston, VA 20190-6242
Registry dates
- Enumerated
- 2014-09-04
- Last updated
- 2014-09-04
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.