MEDICARE: JADE THERAPY AND WELLNESS LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1356275226
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JADE THERAPY AND WELLNESS LLC

Provider Business Mailing Address
First Line	:	5613 POPLAR HALL DR
Second Line	:
City	:	NORFOLK
State	:	VA
Zip	:	23502-4413
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5613 POPLAR HALL DR
Second Line	:
City	:	NORFOLK
State	:	VA
Zip	:	23502-4413
Country	:	US
Telephone Number	:	757-572-6968
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	RAVEN WRIGHT
Credential	:	LCSW
Telephone Number	:	757-572-6968

Provider Enumeration Date	:	06/09/2026
Last Update Date	:	06/09/2026

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