| Rewired Canvas Psychotherapy Llc | |
|
2200 Colonial Ave Ste 12 Norfolk VA 23517-1919 | |
| (757) 589-3498 | |
| Not Available |
| Full Name | Rewired Canvas Psychotherapy Llc |
|---|---|
| Speciality | Counselor |
| Location | 2200 Colonial Ave Ste 12, Norfolk, Virginia |
| Authorized Official Name and Position | Kerry Ann Kruk-borisov (OWNER / MANAGER) |
| Authorized Official Contact | 7575893498 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Rewired Canvas Psychotherapy Llc 2200 Colonial Ave Ste 12 Norfolk VA 23517-1919 Ph: (757) 589-3498 | Rewired Canvas Psychotherapy Llc 2200 Colonial Ave Ste 12 Norfolk VA 23517-1919 Ph: (757) 589-3498 |
| NPI Number | 1457171563 |
|---|---|
| Provider Enumeration Date | 10/14/2024 |
| Last Update Date | 03/27/2025 |
| Certification Date | 03/27/2025 |
| Medicare PECOS PAC ID | 1254860141 |
|---|---|
| Medicare Enrollment ID | O20250122001021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1457171563 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | (* (Not Available)) | Primary |
| 221700000X | Art Therapist | (* (Not Available)) | Secondary |
| Provider Name | Kerry Ann Kruk-borisov |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1316390420 PECOS PAC ID: 2163951054 Enrollment ID: I20250122001162 |
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