Organization
THE WELLNESS GROUP YOUTH & FAMILY SERVICES, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JOHN THOMAS REDD III (CEO)
(540) 368-0614
Entity
Organization
Contact information
Practice address
307 LAFAYETTE BLVD, L1, FREDERICKSBURG, VA 22401-6066
(540) 364-0614
Mailing address
307 LAFAYETTE BLVD, L1, FREDERICKSBURG, VA 22401-6066
(540) 368-0614
(540) 368-0615
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
492-03-003
VA
101YP2500X
Professional Counselor
492-07-004
VA
251E00000X
Home Health Agency
492-03-003
VA
251S00000X
Community/Behavioral Health Agency
Primary
492-03-003
VA
251S00000X
Community/Behavioral Health Agency
492-07-004
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
492
—
VA
01
—
492 03 003
DBHDS
VA
01
—
492 07-004
DBHDS
VA
Enumeration date
12/14/2011
Last updated
12/14/2011
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