Healthcare Provider Details

I. General information

NPI: 1497501167
Provider Name (Legal Business Name): MANIFEST NOW COACHING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2024
Last Update Date: 04/24/2024
Certification Date: 04/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4217 BRIXTON RD
CHESTERFIELD VA
23832-7763
US

IV. Provider business mailing address

4217 BRIXTON RD
CHESTERFIELD VA
23832-7763
US

V. Phone/Fax

Practice location:
  • Phone: 443-449-0703
  • Fax:
Mailing address:
  • Phone: 443-449-0703
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code332U00000X
TaxonomyHome Delivered Meals
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: DANA HOLMES
Title or Position: OWNER/WELLNESS SUPERVISOR
Credential: AAAI/ISMA
Phone: 443-449-0703