1366193666 NPI number — REJUVENATION AND WELLNESS COUNSELING SERVICES, LLC

Table of content: (NPI 1366193666)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366193666 NPI number — REJUVENATION AND WELLNESS COUNSELING SERVICES, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
REJUVENATION AND WELLNESS COUNSELING SERVICES, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1366193666
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/18/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
14321 WINTER BREEZE DR STE 165
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MIDLOTHIAN
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23113-2452
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
804-774-7063
Provider Business Mailing Address Fax Number:
804-774-7066

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
14321 WINTER BREEZE DR STE 165
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MIDLOTHIAN
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23113-2452
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
804-774-7063
Provider Business Practice Location Address Fax Number:
804-774-7066
Provider Enumeration Date:
01/18/2022

Additional Information

Authorized Official

Authorized Official Last Name:
TAYLOR
Authorized Official First Name:
TYLER
Authorized Official Middle Name:
SANELLE
Authorized Official Title or Position:
OWNER/MANAGER
Authorized Official Telephone Number:
804-774-7063

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0904011823 . This is a "VIRGINIA BOARD OF SOCIAL WORK" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com