Healthcare Provider Details

I. General information

NPI: 1770497430
Provider Name (Legal Business Name): THE OCTAVIA THERAPY AND WELLNESS PRACTICE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/30/2026
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

47 DUNN RD
ASHBURNHAM MA
01430-3002
US

IV. Provider business mailing address

47 DUNN RD
ASHBURNHAM MA
01430-3002
US

V. Phone/Fax

Practice location:
  • Phone: 717-802-1180
  • Fax: 351-333-1853
Mailing address:
  • Phone: 717-802-1180
  • Fax: 351-333-1853

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL

VIII. Authorized Official

Name: OCTAVIA NANKUNDA
Title or Position: OWNER/ CLINICIAN
Credential: LMHC
Phone: 717-802-1180