Provider Demographics
NPI:1366193666
Name:REJUVENATION AND WELLNESS COUNSELING SERVICES, LLC
Entity type:Organization
Organization Name:REJUVENATION AND WELLNESS COUNSELING SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:TYLER
Authorized Official - Middle Name:SANELLE
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:804-774-7063
Mailing Address - Street 1:7400 BEAUFONT SPRINGS DR STE 300
Mailing Address - Street 2:
Mailing Address - City:NORTH CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23225-5519
Mailing Address - Country:US
Mailing Address - Phone:804-774-7063
Mailing Address - Fax:804-487-8097
Practice Address - Street 1:7400 BEAUFONT SPRINGS DRIVE
Practice Address - Street 2:SUITE 300
Practice Address - City:NORTH CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23225-5519
Practice Address - Country:US
Practice Address - Phone:804-774-7063
Practice Address - Fax:804-487-8097
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-18
Last Update Date:2025-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0904011823OtherVIRGINIA BOARD OF SOCIAL WORK