MEDICARE: THE WELLNESS INSTITUTE, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor
2	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1235753476
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE WELLNESS INSTITUTE, LLC

Provider Business Mailing Address
First Line	:	806 N 30TH ST
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23223-6641
Country	:	US
Telephone Number	:	804-241-2324
Fax Number	:	804-293-3802

Provider Business Practice Location Address
First Line	:	2120 STAPLES MILL RD STE 211
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23230-2917
Country	:	US
Telephone Number	:	804-241-2324
Fax Number	:

Authorized Official
Title or Position	:	CO-OWNER
Name	:	MS. CARLA RANDOLPH
Credential	:	LCSW, CSAC
Telephone Number	:	804-241-2324

Provider Enumeration Date	:	06/03/2020
Last Update Date	:	01/21/2025

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