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General NPI Number Information
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NPI Number | 1104287804
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Entity Type | Organization
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Legal Business Name | REVIVING WELLNESS COUNSELING
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Dates
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Enumeration Date | 03/09/2016
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Last Update Date | 07/24/2020
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Provider Practice Location Address
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Address Line | 3630 S PLAZA TRL STE 150A
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City | VIRGINIA BEACH
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State | VA
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Zip | 23452-3371
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Country | US
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Telephone | 757-373-5128
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Fax | 757-431-0700
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Provider Business Mailing Address
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Address Line | 3630 S PLAZA TRL STE 150A
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City | VIRGINIA BEACH
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State | VA
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Zip | 23452-3371
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Country | US
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Telephone | 757-373-5128
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Fax | 757-431-0700
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Authorized Official
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Title or Position | PRACTICE OWNER
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Name | MRS. TINA ROBIN CURRAN-TAYLOR
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Credential | LPC
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Telephone | 757-373-5128
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 0701004008
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License Number State | VA
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