Healthcare Provider Details

I. General information

NPI: 1093250540
Provider Name (Legal Business Name): CIRCLE OF WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/19/2016
Last Update Date: 03/17/2025
Certification Date: 03/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9321 MIDLOTHIAN TPKE STE C
NORTH CHESTERFIELD VA
23235-4941
US

IV. Provider business mailing address

9321 MIDLOTHIAN TPKE STE C
NORTH CHESTERFIELD VA
23235-4941
US

V. Phone/Fax

Practice location:
  • Phone: 804-252-4525
  • Fax: 804-597-0213
Mailing address:
  • Phone: 804-252-4525
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number0904009706
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. LONNELL F LEWIS
Title or Position: LICENSED CLINICAL SOCIAL WORKER
Credential: LCSW
Phone: 434-806-3869