MEDICARE: 5IVE STAR D & D FILM-MUSIC & PRODUCTIONS LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	101YM0800X	Mental Health Counselor
2	101200000X	Drama Therapist
3	101YP1600X	Pastoral Counselor
4	101YP2500X	Professional Counselor
5	102X00000X	Poetry Therapist
6	106S00000X	Behavior Technician
7	146D00000X	Personal Emergency Response Attendant
8	163WC0400X	Case Management Registered Nurse
9	221700000X	Art Therapist
10	363LG0600X	Gerontology Nurse Practitioner
11	374K00000X	Religious Nonmedical Practitioner
12	374U00000X	Home Health Aide
13	376K00000X	Nurse's Aide
14	390200000X	Student in an Organized Health Care Education/Training Program
15	405300000X	Prevention Professional

General Provider Information

NPI Number	:	1396607545
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	5IVE STAR D & D FILM-MUSIC & PRODUCTIONS LLC

Provider Business Mailing Address
First Line	:	1236 W WASHINGTON ST
Second Line	:
City	:	PETERSBURG
State	:	VA
Zip	:	23803-3923
Country	:	US
Telephone Number	:	347-717-1500
Fax Number	:

Provider Business Practice Location Address
First Line	:	1236 W WASHINGTON ST
Second Line	:
City	:	PETERSBURG
State	:	VA
Zip	:	23803-3923
Country	:	US
Telephone Number	:	347-717-1500
Fax Number	:

Authorized Official
Title or Position	:	SOLE MEMBER, EXECUTIVE DIRECTOR
Name	:	MS. CRYSTAL A NEVERSON
Credential	:
Telephone Number	:	347-717-1500

Provider Enumeration Date	:	11/25/2025
Last Update Date	:	12/25/2025

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