Provider Demographics
NPI:1497319842
Name:RICHMOND WELLNESS CENTER
Entity Type:Organization
Organization Name:RICHMOND WELLNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OUTPATIENT COUNSELOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:HUERKAMP
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:601-506-2122
Mailing Address - Street 1:1405 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23220-4629
Mailing Address - Country:US
Mailing Address - Phone:601-506-2122
Mailing Address - Fax:
Practice Address - Street 1:1405 W MAIN ST
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23220-4629
Practice Address - Country:US
Practice Address - Phone:601-506-2122
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-30
Last Update Date:2019-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty