Rewired Canvas Psychotherapy LLC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

Legal business name

REWIRED CANVAS PSYCHOTHERAPY LLC

Practice address

2200 Colonial Ave Ste 12
Norfolk, VA 23517-1919

Phone

(757) 589-3498

NPI assigned

Oct 14, 2024

Last updated

Mar 27, 2025By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Kerry Ann Kruk-Borisov, LPC, ATR-BC, CSACNPI 1316390420

Title

Owner / Manager

Phone

(757) 589-3498

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in VA

Enrollment records 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Kerry Ann Kruk-Borisov, LPC, ATR-BC, CSAC

  • Professional Counselor
  • Norfolk, VA
  • NPI 1316390420
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1728864000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1743033600000",
    "number": "1457171563",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2200 COLONIAL AVE STE 12",
            "city": "NORFOLK",
            "state": "VA",
            "postal_code": "235171919",
            "telephone_number": "757-589-3498"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2200 COLONIAL AVE STE 12",
            "city": "NORFOLK",
            "state": "VA",
            "postal_code": "235171919",
            "telephone_number": "757-589-3498"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REWIRED CANVAS PSYCHOTHERAPY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-10-14",
        "last_updated": "2025-03-27",
        "certification_date": "2025-03-27",
        "status": "A",
        "authorized_official_last_name": "KRUK-BORISOV",
        "authorized_official_first_name": "KERRY",
        "authorized_official_middle_name": "ANN",
        "authorized_official_title_or_position": "OWNER / MANAGER",
        "authorized_official_telephone_number": "757-589-3498",
        "authorized_official_credential": "LPC, ATR-BC, CSAC"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "221700000X",
            "taxonomy_group": "",
            "desc": "Art Therapist",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Nicholas Battista Rettenmaier, MD
• Joan Musiimenta Reveles
• Bonnie Caukins Revelle, MD
• Revitalize Behavioral Services, LLC
• Revitalize Function LLC
• Amber Lynn Reyes, PA
• James Reyes
• Janet A Reyes
• Matthew Reyes
• Jillian Reynolds, DDS

• Professional Counselor in Norfolk, VA
• Providers in Norfolk, VA by specialty
• Professional Counselor in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 27, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.