Provider Demographics
NPI:1114296571
Name:THE WELLNESS GROUP YOUTH & FAMILY SERVICES, INC.
Entity Type:Organization
Organization Name:THE WELLNESS GROUP YOUTH & FAMILY SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:REDD
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:540-368-0614
Mailing Address - Street 1:307 LAFAYETTE BLVD
Mailing Address - Street 2:L1
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22401-6066
Mailing Address - Country:US
Mailing Address - Phone:540-368-0614
Mailing Address - Fax:540-368-0615
Practice Address - Street 1:307 LAFAYETTE BLVD
Practice Address - Street 2:L1
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22401-6066
Practice Address - Country:US
Practice Address - Phone:540-364-0614
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-14
Last Update Date:2011-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA492-03-003101YM0800X, 251E00000X, 251S00000X
VA492-07-004101YP2500X, 251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
No251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA492Medicaid
VA492 07-004OtherDBHDS
VA492 03 003OtherDBHDS