Rewild, PLLC

Primary specialty

Adult Mental Health Clinic/CenterTaxonomy code 261QM0850X

Legal business name

REWILD, PLLC

Doing business as

Rewild Psychotherapy

Practice address

401 North 27TH St
Richmond, VA 23223

Phone

(240) 753-2583

NPI assigned

Aug 21, 2024

Organization subpart

No

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

Authorized official

Name

Dr. Celeste Kelly, PSY.D.NPI 1699385013

Title

Owner, Clinical Psychologist

Phone

(240) 753-2583

Specialties & licenses 1

Addresses

Other names 1

• Rewild Psychotherapy Doing business as

Locations

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.

• Celeste Macdonald Kelly, PSYD

  • Clinical Psychologist
  • Midlothian, VA
  • NPI 1699385013
  NPD Authorized official

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

{
    "created_epoch": "1724198400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1724198400000",
    "number": "1912730458",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5806 GROVE AVE # 122",
            "city": "RICHMOND",
            "state": "VA",
            "postal_code": "232262630",
            "telephone_number": "240-753-2583"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "401 NORTH 27TH ST",
            "city": "RICHMOND",
            "state": "VA",
            "postal_code": "23223",
            "telephone_number": "240-753-2583"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REWILD, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-08-21",
        "last_updated": "2024-08-21",
        "certification_date": "2024-08-16",
        "status": "A",
        "authorized_official_last_name": "KELLY",
        "authorized_official_first_name": "CELESTE",
        "authorized_official_title_or_position": "OWNER, CLINICAL PSYCHOLOGIST",
        "authorized_official_telephone_number": "240-753-2583",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PSY.D."
    },
    "taxonomies": [
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Rewild Psychotherapy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Revelations Behavioral Health LLC
• Emily A Revenson, PAC
• Revision Counseling, LLC
• Revolution Healthcare LLC
• Revolution Hearing
• Rebekah Barrett Rexrode
• Jose Salvador Reyes, MD
• Kaylee Reyes
• Marlon Reyes
• Oscar Rolando Reyes Jr., MD

• Adult Mental Health Clinic/Center in Richmond, VA
• Providers in Richmond, VA by specialty
• Adult Mental Health Clinic/Center in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 21, 2024; 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.