Provider Demographics
NPI:1245936616
Name:REDEFINE THERAPY, LLC
Entity type:Organization
Organization Name:REDEFINE THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:L
Authorized Official - Last Name:STACY
Authorized Official - Suffix:
Authorized Official - Credentials:LPC,CSAC
Authorized Official - Phone:757-632-0343
Mailing Address - Street 1:1216 GRANBY ST STE 211
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23510-2622
Mailing Address - Country:US
Mailing Address - Phone:757-632-0343
Mailing Address - Fax:757-974-9374
Practice Address - Street 1:1216 GRANBY ST STE 211
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23510-2622
Practice Address - Country:US
Practice Address - Phone:757-632-0343
Practice Address - Fax:757-974-9374
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-06
Last Update Date:2024-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1306182795Medicaid