Healthcare Provider Details

I. General information

NPI: 1972421550
Provider Name (Legal Business Name): 360HEALING PATH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2026
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 PARK WEST CIR STE 306N
MIDLOTHIAN VA
23114-5552
US

IV. Provider business mailing address

1 PARK WEST CIR STE 306N
MIDLOTHIAN VA
23114-5552
US

V. Phone/Fax

Practice location:
  • Phone: 434-603-9027
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: TULANY MUPANDASEKWA
Title or Position: OWNER
Credential:
Phone: 434-603-9027