Provider Demographics
NPI:1104287804
Name:REVIVING WELLNESS COUNSELING
Entity type:Organization
Organization Name:REVIVING WELLNESS COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TINA
Authorized Official - Middle Name:ROBIN
Authorized Official - Last Name:CURRAN-TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:757-373-5128
Mailing Address - Street 1:3630 S PLAZA TRL STE 150A
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23452-3371
Mailing Address - Country:US
Mailing Address - Phone:757-373-5128
Mailing Address - Fax:757-431-0700
Practice Address - Street 1:3630 S PLAZA TRL STE 150A
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23452-3371
Practice Address - Country:US
Practice Address - Phone:757-373-5128
Practice Address - Fax:757-431-0700
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-09
Last Update Date:2020-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701004008101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA004945395Medicaid