Provider Demographics
NPI:1366980914
Name:THE ROCKBRIDGE WELLNESS GROUP
Entity type:Organization
Organization Name:THE ROCKBRIDGE WELLNESS GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER/THERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:KEITH
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, LPC, NCC
Authorized Official - Phone:540-797-5703
Mailing Address - Street 1:205 S RANDOLPH ST
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:24450-2366
Mailing Address - Country:US
Mailing Address - Phone:540-572-0667
Mailing Address - Fax:
Practice Address - Street 1:205 S RANDOLPH ST
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:VA
Practice Address - Zip Code:24450-2366
Practice Address - Country:US
Practice Address - Phone:540-572-0667
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-03
Last Update Date:2017-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701005500101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty