Healthcare Provider Details

I. General information

NPI: 1588547913
Provider Name (Legal Business Name): MONARCH DEVELOPMENT CENTER INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/31/2025
Last Update Date: 07/31/2025
Certification Date: 07/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 PICKWICK AVE
COLONIAL HEIGHTS VA
23834-3456
US

IV. Provider business mailing address

17 DAHLGREN RD
RICHMOND VA
23238-6103
US

V. Phone/Fax

Practice location:
  • Phone: 804-225-0749
  • Fax: 804-225-0753
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: DR. KHIDHRA S POOLE
Title or Position: ADMINISTRATOR
Credential: LCSW
Phone: 804-551-7363