Healthcare Provider Details

I. General information

NPI: 1952050353
Provider Name (Legal Business Name): CONNECTED WELLNESS GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/22/2022
Last Update Date: 07/06/2022
Certification Date: 07/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

327 W 21ST ST STE 205
NORFOLK VA
23517-2130
US

IV. Provider business mailing address

PO BOX 11611
NORFOLK VA
23517-0611
US

V. Phone/Fax

Practice location:
  • Phone: 757-656-6461
  • Fax:
Mailing address:
  • Phone: 757-593-0303
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: RACHEL HARNER
Title or Position: OWNER
Credential: LPC
Phone: 757-593-0303