Provider Demographics
NPI:1922546746
Name:FAMILY WELLNESS AND RECOVERY CENTER, LLC
Entity Type:Organization
Organization Name:FAMILY WELLNESS AND RECOVERY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:GLORIA
Authorized Official - Middle Name:ROBIN
Authorized Official - Last Name:POLITE
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:757-962-9644
Mailing Address - Street 1:5121 E. VIRGINIA BEACH BLVD, SUITE C-2
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23502-4041
Mailing Address - Country:US
Mailing Address - Phone:757-962-9644
Mailing Address - Fax:757-383-6135
Practice Address - Street 1:5121 E. VIRGINIA BEACH BLVD, SUITE C-2
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23502-4041
Practice Address - Country:US
Practice Address - Phone:757-962-9644
Practice Address - Fax:757-383-6135
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-01
Last Update Date:2017-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
95221101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty