Healthcare Provider Details

I. General information

NPI: 1003388026
Provider Name (Legal Business Name): THE MULE GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/02/2019
Last Update Date: 07/18/2022
Certification Date: 07/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

840 JUNIPER CRES STE 112
CHESAPEAKE VA
23320-2628
US

IV. Provider business mailing address

2005 OLD GREENBRIER RD STE 102
CHESAPEAKE VA
23320-2649
US

V. Phone/Fax

Practice location:
  • Phone: 757-762-1831
  • Fax:
Mailing address:
  • Phone: 757-790-5916
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name: CHINIQUA RADFORD
Title or Position: OWNER AND PROFESSIONAL COUNSELOR
Credential: MA, MS, CSAC, LPC
Phone: 757-214-3159