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NPI Code Detail

MEDICARE: STARFISH WELLNESS AND THERAPEUTIC

MEDICARE: STARFISH WELLNESS AND THERAPEUTIC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261QM0801XMental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number : 1275117756
Entity Type Code : Organization
Provider Name (Legal Business Name) : STARFISH WELLNESS AND THERAPEUTIC
Provider Business Mailing Address
First Line : 4860 COX RD STE 200
Second Line :
City : GLEN ALLEN
State : VA
Zip : 23060-9248
Country : US
Telephone Number : 804-210-2360
Fax Number :
Provider Business Practice Location Address
First Line : 4860 COX RD STE 200
Second Line :
City : GLEN ALLEN
State : VA
Zip : 23060-9248
Country : US
Telephone Number : 804-210-2360
Fax Number :
Authorized Official
Title or Position : OWNER
Name : ALEXANDREA JACKSON
Credential : LPC
Telephone Number : 804-210-2360
Provider Enumeration Date : 05/10/2021
Last Update Date : 05/10/2021

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Directions to “STARFISH WELLNESS AND THERAPEUTIC ” Practice Location

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These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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