Provider Demographics
NPI:1952050353
Name:CONNECTED WELLNESS GROUP LLC
Entity Type:Organization
Organization Name:CONNECTED WELLNESS GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RACHEL
Authorized Official - Middle Name:
Authorized Official - Last Name:HARNER
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:757-593-0303
Mailing Address - Street 1:PO BOX 11611
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23517-0611
Mailing Address - Country:US
Mailing Address - Phone:757-593-0303
Mailing Address - Fax:
Practice Address - Street 1:327 W 21ST ST STE 205
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23517-2130
Practice Address - Country:US
Practice Address - Phone:757-656-6461
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-22
Last Update Date:2022-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty