| Redefine Therapy, Llc | |
|
1216 Granby St Ste 211 Norfolk VA 23510-2622 | |
| (757) 632-0343 | |
| (757) 974-9374 |
| Full Name | Redefine Therapy, Llc |
|---|---|
| Speciality | Counselor - Professional |
| Location | 1216 Granby St Ste 211, Norfolk, Virginia |
| Authorized Official Name and Position | John L Stacy (OWNER/THERAPIST) |
| Authorized Official Contact | 7576320343 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Redefine Therapy, Llc 1216 Granby St Ste 211 Norfolk VA 23510-2622 Ph: (757) 632-0343 | Redefine Therapy, Llc 1216 Granby St Ste 211 Norfolk VA 23510-2622 Ph: (757) 632-0343 |
| NPI Number | 1245936616 |
|---|---|
| Provider Enumeration Date | 02/06/2023 |
| Last Update Date | 07/01/2024 |
| Certification Date | 07/01/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1245936616 | NPI | - | NPPES |
| 1306182795 | Medicaid | VA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | (* (Not Available)) | Primary |
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