Healthcare Provider Details

I. General information

NPI: 1659242949
Provider Name (Legal Business Name): EMBODIED BY ME, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/17/2025
Last Update Date: 09/17/2025
Certification Date: 09/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13918 SEATTLE SLEW LN
MIDLOTHIAN VA
23112-1538
US

IV. Provider business mailing address

PO BOX 4093
MIDLOTHIAN VA
23112-0001
US

V. Phone/Fax

Practice location:
  • Phone: 804-944-5695
  • Fax:
Mailing address:
  • Phone: 804-944-5695
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225800000X
TaxonomyRecreation Therapist
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number State

VIII. Authorized Official

Name: KRYSTAL LA'TRESE PINCKNEY
Title or Position: OWNER
Credential: CTRS, C-IAYT
Phone: 804-944-5695