Healthcare Provider Details

I. General information

NPI: 1205770898
Provider Name (Legal Business Name): HEALING HEARTS RECOVERY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/15/2026
Last Update Date: 04/15/2026
Certification Date: 04/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9613 KRAUSE RD
CHESTERFIELD VA
23832-6718
US

IV. Provider business mailing address

9613 KRAUSE RD
CHESTERFIELD VA
23832-6718
US

V. Phone/Fax

Practice location:
  • Phone: 804-223-6962
  • Fax: 686-277-7738
Mailing address:
  • Phone: 804-223-6962
  • Fax: 686-277-7738

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name: RAYSEAN EDWARDS
Title or Position: EXECUTIVE ADMINISTRATOR
Credential:
Phone: 804-223-6962