Healthcare Provider Details

I. General information

NPI: 1457275950
Provider Name (Legal Business Name): 1925 LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/06/2026
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1420 MOUNTAIN RD
GLEN ALLEN VA
23060-3912
US

IV. Provider business mailing address

1420 MOUNTAIN RD
GLEN ALLEN VA
23060-3912
US

V. Phone/Fax

Practice location:
  • Phone: 804-922-6323
  • Fax: 804-500-6931
Mailing address:
  • Phone: 804-922-6323
  • Fax: 804-500-6931

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: GABRIELLE WILLIAMS
Title or Position: OWNER
Credential: LCSW
Phone: 804-922-6323