MEDICARE: WAYVINE SERVICES, PLLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	101YM0800X	Mental Health Counselor
2	104100000X	Social Worker
3	1041S0200X	School Social Worker
4	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1659167427
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WAYVINE SERVICES, PLLC

Provider Business Mailing Address
First Line	:	6841 FOREST HILL AVE UNIT 365
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23225-1603
Country	:	US
Telephone Number	:	804-509-1559
Fax Number	:

Provider Business Practice Location Address
First Line	:	928 1/2 N HAMILTON ST
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23221-1204
Country	:	US
Telephone Number	:	989-370-3011
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	KELLY RESZKA
Credential	:	LCSW
Telephone Number	:	804-509-1559

Provider Enumeration Date	:	04/17/2025
Last Update Date	:	04/17/2025

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Directions to “WAYVINE SERVICES, PLLC ” Practice Location

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