Modern Wellness, LLC

Primary specialty

CounselorTaxonomy code 101Y00000X

Legal business name

MODERN WELLNESS, LLC

Practice address

2855 Red Lane Rd
Powhatan, VA 23139-5121

Phone

(804) 382-0811

NPI assigned

May 18, 2021

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Brandi Long, LPCNPI 1619111069

Title

Owner

Phone

(804) 382-0811

Specialties & licenses 1

Addresses

Electronic endpoints 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Brandi Long, LPC

  • Mental Health Counselor
  • Powhatan, VA
  • NPI 1619111069
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1621296000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1621296000000",
    "number": "1124692876",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2855 RED LANE RD",
            "city": "POWHATAN",
            "state": "VA",
            "postal_code": "231395121",
            "telephone_number": "804-382-0811"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2855 RED LANE RD",
            "city": "POWHATAN",
            "state": "VA",
            "postal_code": "231395121",
            "telephone_number": "804-382-0811"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MODERN WELLNESS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-05-18",
        "last_updated": "2021-05-18",
        "certification_date": "2021-05-18",
        "status": "A",
        "authorized_official_last_name": "LONG",
        "authorized_official_first_name": "BRANDI",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "804-382-0811",
        "authorized_official_credential": "LPC"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Counselor",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "https://www.simplepractice.com/",
            "affiliation": "N",
            "endpointDescription": "Electronic Health Record",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "2855 Red Lane Rd",
            "city": "Powhatan",
            "state": "VA",
            "country_code": "US",
            "postal_code": "231395121",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Erin McCabe, O.D.
• Austin Walsh McDade, DC
• Alyssa Claire McGinnis, LMSW
• Allison Middleton
• Charlene Shenita Miles
• Molly Cage LLC
• Carol Montgomery-Jennings, MA LCSW
• Kelly J Munyat-Donnelly, D.C.
• Latisha C Murray, M.D.
• Donald Robert Murry III, DMD

• All providers in Powhatan, VA
• Counselor in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 18, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.