Healthcare Provider Details

I. General information

NPI: 1356275226
Provider Name (Legal Business Name): JADE THERAPY AND WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2026
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5613 POPLAR HALL DR
NORFOLK VA
23502-4413
US

IV. Provider business mailing address

5613 POPLAR HALL DR
NORFOLK VA
23502-4413
US

V. Phone/Fax

Practice location:
  • Phone: 757-572-6968
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: RAVEN WRIGHT
Title or Position: OWNER
Credential: LCSW
Phone: 757-572-6968