Healthcare Provider Details

I. General information

NPI: 1114814399
Provider Name (Legal Business Name): BEACON OF WELLNESS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/20/2025
Last Update Date: 04/21/2026
Certification Date: 04/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8401 MAYLAND DR STE P
RICHMOND VA
23294-4648
US

IV. Provider business mailing address

8401 MAYLAND DR STE P
RICHMOND VA
23294-4648
US

V. Phone/Fax

Practice location:
  • Phone: 804-251-1217
  • Fax:
Mailing address:
  • Phone: 804-251-1217
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: KYNETTA BELL
Title or Position: ADMINISTRATOR
Credential: MS, LMSW
Phone: 804-251-1217