Healthcare Provider Details

I. General information

NPI: 1881374148
Provider Name (Legal Business Name): AYLA CODA GARCIA MS, QMHP-A, QDDP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/21/2023
Last Update Date: 07/21/2023
Certification Date: 07/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2807 N PARHAM RD STE 260
HENRICO VA
23294-4414
US

IV. Provider business mailing address

2807 N PARHAM RD STE 260
HENRICO VA
23294-4414
US

V. Phone/Fax

Practice location:
  • Phone: 804-315-3177
  • Fax: 804-315-0202
Mailing address:
  • Phone: 804-315-3177
  • Fax: 804-315-0202

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0732007540
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: