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General NPI Number Information
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NPI Number | 1922546746
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Entity Type | Organization
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Legal Business Name | FAMILY WELLNESS AND RECOVERY CENTER, LLC
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Dates
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Enumeration Date | 02/01/2017
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Last Update Date | 02/01/2017
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Provider Practice Location Address
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Address Line | 5121 E. VIRGINIA BEACH BLVD, SUITE C-2
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City | NORFOLK
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State | VA
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Zip | 23502-4041
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Country | US
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Telephone | 757-962-9644
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Fax | 757-383-6135
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Provider Business Mailing Address
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Address Line | 5121 E. VIRGINIA BEACH BLVD, SUITE C-2
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City | NORFOLK
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State | VA
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Zip | 23502-4041
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Country | US
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Telephone | 757-962-9644
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Fax | 757-383-6135
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MRS. GLORIA ROBIN POLITE
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Credential | LPC
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Telephone | 757-962-9644
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 95221
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License Number State |
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